☆ 4.7 Article

Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus

INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS (2013)

期刊

INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS

卷 41, 期 2, 页码 137-142

出版社

ELSEVIER SCIENCE BV

DOI: 10.1016/j.ijantimicag.2012.10.013

关键词

Antimicrobial stewardship; Clostridium difficile; MRSA; ESBL-producing coliforms; Hospital-acquired infection

类别

Infectious Diseases Microbiology Pharmacology & Pharmacy

向作者/读者索取更多资源

Protocol

社区支持

Reagent

社区支持

摘要

A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL)-producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P < 0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P = 0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens. (C) 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

作者

我是这篇论文的作者

点击您的名字以认领此论文并将其添加到您的个人资料中。

主要评分

4.7

评分不足

次要评分

新颖性

重要性

科学严谨性

评价这篇论文

Comparison of Risk Stratification Approaches to Identify Patients with Clostridioides difficile Infection at Risk for Multidrug-Resistant Organism Gut Microbiota Colonization

Evan J. Zasowski, Maryam Ali, Ada Anugo, Nayle Ibragimova, Kierra M. Dotson, Bradley T. Endres, Khurshida Begum, M. Jahangir Alam, Kevin W. Garey

Summary: This study aimed to develop predictive indices for multidrug-resistant organism (MDRO) gut colonization in patients with Clostridioides difficile infection (CDI). They compared the predictive performance of a regression-based risk score with two other simplified risk stratification approaches. The results showed that a simplified approach using prior healthcare exposure and receipt of prior antibiotics was as effective as individual patient/antibiotic risk modeling in identifying patients at risk for MDRO gut colonization.

INFECTIOUS DISEASES AND THERAPY (2023)