Leaked internal report criticizes government oversight of antimicrobial resistance.

sight of antimicrobial resistance is sorely plagued by deficiencies, according to a draft report prepared by officials at the Public Health Agency of Canada (PHAC). The internal government report, Antimicrobial Resistance in Canada: A Gap Analysis, argues that the government needs to tackle a series of “key” deficiencies in its current efforts to address antimicrobial resistance (AMR). Those include the: • “absence of a national AMR surveillance system or plan; • absence of an AMR governance structure or action plan; • absence of a governance structure for antimicrobial stewardship; [and] • absence of coherent federal AMR policy.” The report, currently being circulated amongst members of an antimicrobial resistance task force, describes antimicrobial resistance as a “growing problem” that will undermine “government efforts to improve quality of health care, to increase access and to decrease wait times.” In support of that proposition, the report estimates that antibiotic-resistant health care-associated infections are associated with a nearly 30% increase in hospital costs. “Delayed or inappropriate therapy for infections caused by resistant organisms may result in longer hospital stays and a need for additional care. ... Limited treatment options may also add to the burden as more expensive and/or toxic therapies may be required.” The report’s recommendations closely match advice given to PHAC by the now-disbanded Canadian Committee on Antibiotic Resistance in 2009 (www.cmaj.ca/lookup/doi/10.1503/cmaj .109-3109). The World Health Organization has called on Canada and other member nations to estimate the costs of all elements of a national antimicrobial resistance plan, “develop a complete budget, and integrate it into the national health budget and other relevant budgets” (www.who.int/world-health-day/2011 /presskit/WHDIntrototobriefs.pdf). PHAC officials note in the report that Canada lags behind Australia, the United States, the United Kingdom and other countries in Europe in developing antibiotic use guidelines. As well, “existing surveillance systems only capture some of the data identified as critical for comprehensive AMR surveillance,” the report states. “Limited data are available regarding antimicrobial usage in non-hospital settings, notably in the community and in the agri-food sector.” It also notes that the use of human drugs in meat News CMAJ