Infection control team activity and recent antibiograms in the Kobe University Hospital

Comparison between antimicrobial stewardship program and intervention by infection control team for managing antibiotic use in neurogenic bladder-related urinary tract infection patients: A retrospective chart audit

BACKGROUND

Antimicrobial prescriptions are relatively common in urologic outpatients. Therefore, it is necessary to investigate the impact of antimicrobial stewardship program (ASP) interventions.

METHODS

In urology outpatients, antimicrobial use density (AUD), antimicrobial agent costs, isolation of urinary tract infection (UTI)-causing organisms and their antimicrobial susceptibilities were compared between intervention by infection control team (ICT) era (pre-2014) and ASP era (post-2014) in 2739 patients with lower urinary tract symptoms, including neurogenic bladder patients with UTI or suspected UTI, from 2011 to 2020.

RESULTS

In the ASP, overall AUD (P<.001), cefotiam (CTM) (P=.0013), 2nd-generation cephalosporins (P=.026), cefdinir (CFDN) (P<.001), levofloxacin (LVFX) (P<.001), sitafloxacin (STFX) (P=.0016), and tosufloxacin (TFLX) (P=.0044) showed a significant decrease, but cefaclor (P=.019) showed a significant increase. Regarding antimicrobial agent costs, overall (P=.016), CTM (P=.021), 2nd-generation cephalosporins (P=.033), CFDN (P=.016), LVFX (P=.016), STFX (P=.033), and TFLX (P=.033) showed a significant decrease in the ASP. UTI-causing antimicrobial susceptibilities, CTM (P=.035), LVFX (P=.026) and sulfamethoxazole/trimethoprim (P=.048) in E. coli, and minocycline (P=.026) in K. pneumoniae showed a significant improve in the ASP.

CONCLUSION

ASP contributed to decrease AUD and antimicrobial agent costs, and to improve antimicrobial susceptibilities of E. coli and K. pneumoniae to several antibiotics, compared to ICT. Further prospective studies are necessary for definitive conclusions.

Clinical Implication of the Relationship between Antimicrobial Resistance and Infection Control Activities in Japanese Hospitals: A Principal Component Analysis-Based Cluster Analysis

There are few multicenter investigations regarding the relationship between antimicrobial resistance (AMR) and infection-control activities in Japanese hospitals. Hence, we aimed to identify Japanese hospital subgroups based on facility characteristics and infection-control activities. Moreover, we evaluated the relationship between AMR and hospital subgroups. We conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in 124 hospitals from April 2016 to March 2017. Hospitals were classified using cluster analysis based the principal component analysis-transformed data. We assessed the relationship between each cluster and AMR using analysis of variance. Ten variables were selected and transformed into four principal components, and five clusters were identified. Cluster 5 had high infection control activity. Cluster 2 had partially lower activity of infection control than the other clusters. Clusters 3 and 4 had a higher rate of surgeries than Cluster 1. The methicillin-resistant Staphylococcus aureus (MRSA)/S. aureus detection rate was lowest in Cluster 1, followed, respectively, by Clusters 5, 2, 4, and 3. The MRSA/S. aureus detection rate differed significantly between Clusters 4 and 5 (p = 0.0046). Our findings suggest that aggressive examination practices are associated with low AMR whereas surgeries, an infection risk factor, are associated with high AMR.

Evaluating effectiveness of infection control efforts in hospitals using information in microbiological laboratory databases

Purpose

To analyze the quality of infection control activities, bacteriological data relevant to infection control was evaluated through the microbiological data warehouse networking hospitals in two medical regions.

Methods

Data regarding bacterial test results of 19 hospitals were extracted from two microbiological laboratory information data bases. The rate of MRSA among total S. aureus was used as a general indicator of infection control activities. The occupancy rate of nasal or pharyngeal swabs among MRSA‐positive bacteriological samples was used as an indicator of attention paid for infection control in intensive care wards. The number of blood culture sets per examined patient was utilized as an indicator for life‐long vocational education on updated medical practice relevant to infectious diseases.

Results

The rate of MRSA was significantly higher in secondary private hospitals. The occupancy rate of nasal or pharyngeal swabs was significantly higher in tertiary hospitals. The average number of blood culture set per examined patient were 1.55, 1.54 and 1.39 in tertiary, secondary public and secondary private hospitals, respectively; however, there were no statistical differences between groups.

Conclusions

Data bases of microbiological test results shared by hospital laboratories are useful for evaluating regional infection control activities.