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Jover-Sáenz A, Ramírez-Hidalgo M, Bellés Bellés A, Ribes Murillo E, Batlle Bosch M, Ribé Miró A, Mari López A, Cayado Cabanillas J, Piqué Palacín N, Garrido-Calvo S, Ortiz Valls M, Gracia Vilas MI, Gros Navés L, Javierre Caudevilla MJ, Montull Navarro L, Bañeres Argiles C, Vaqué Castilla P, Ichart Tomás JJ, Saura Codina M, Andreu Mayor E, Martorell Solé R, Vena Martínez A, Albalad Samper JM, Cano Marrón S, Soler Elcacho C, Rodríguez Garrocho A, Terrer Manrique G, Solé Curcó A, Escuin DDLR, Estadella Servalls MJ, Figueres Farreny AM, Montaña Esteban LM, Sanz Borrell L, Morales Valle A, Pallerola Planes M, Hamadi A, Pujol Aymerich F, Toribio Redondo F, Urgelés Castillón MC, Valgañon Palacios J, Olivart Parejo M, Torres-Puig-gros J. Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-Resistant Staphylococcus aureus Strains across a Region of Catalunya (Spain) over 5 Years. Antibiotics (Basel) 2024; 13:92. [PMID: 38247651 PMCID: PMC10812605 DOI: 10.3390/antibiotics13010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Primary care antimicrobial stewardship program (ASP) interventions can reduce the over-prescription of unnecessary antibiotics, but the impact on the reduction in bacterial resistance is less known, and there is a lack of available data. We implemented a prolonged educational counseling ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, which was compared to a pre-intervention period, a significant reduction in antibiotic prescriptions occurred, particularly those associated with greater harmful effects and resistance selection. There was also a decrease in methicillin-resistant Staphylococcus aureus (MRSA) strains and in their co-resistance to other antibiotics, particularly those with an ecological impact.
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Affiliation(s)
- Alfredo Jover-Sáenz
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain;
| | - María Ramírez-Hidalgo
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain;
| | - Alba Bellés Bellés
- Sección de Microbiología, Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain;
| | - Esther Ribes Murillo
- Unidad de Farmacia de Atención Primaria, Institut Català de la Salut (ICS), 25007 Lleida, Spain;
| | - Meritxell Batlle Bosch
- Equipo de Atención Priamaria (EAP) Les Borges Blanques, 25400 Lleida, Spain; (M.B.B.); (A.R.M.)
| | - Anna Ribé Miró
- Equipo de Atención Priamaria (EAP) Les Borges Blanques, 25400 Lleida, Spain; (M.B.B.); (A.R.M.)
| | - Alba Mari López
- EAP Pla d’Urgell, 25001 Lleida, Spain; (A.M.L.); (J.C.C.); (N.P.P.)
| | | | | | | | | | | | | | | | | | | | | | - José Javier Ichart Tomás
- Servicio de Urgencias, Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain; (J.J.I.T.); (M.S.C.)
| | - Mireia Saura Codina
- Servicio de Urgencias, Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain; (J.J.I.T.); (M.S.C.)
| | | | | | - Ana Vena Martínez
- Servei de Geriatria, Hospital Universitari Santa Maria, 25198 Lleida, Spain;
| | | | - Susana Cano Marrón
- EAP Onze de Setembre, 25005 Lleida, Spain; (S.C.M.); (C.S.E.); (A.R.G.); (G.T.M.)
| | | | | | | | | | | | | | | | | | | | | | | | - Aly Hamadi
- EAP Balaguer, 25600 Lleida, Spain; (M.P.P.); (A.H.)
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Laffont-Lozes P, Larcher R, Salipante F, Leguelinel-Blache G, Dunyach-Remy C, Lavigne JP, Sotto A, Loubet P. Usefulness of dynamic regression time series models for studying the relationship between antimicrobial consumption and bacterial antimicrobial resistance in hospitals: a systematic review. Antimicrob Resist Infect Control 2023; 12:100. [PMID: 37697357 PMCID: PMC10496333 DOI: 10.1186/s13756-023-01302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUNG Antimicrobial resistance (AMR) is on the rise worldwide. Tools such as dynamic regression (DR) models can correlate antimicrobial consumption (AMC) with AMR and predict future trends to help implement antimicrobial stewardship programs (ASPs). MAIN BODY We carried out a systematic review of the literature up to 2023/05/31, searching in PubMed, ScienceDirect and Web of Science. We screened 641 articles and finally included 28 studies using a DR model to study the correlation between AMC and AMR at a hospital scale, published in English or French. Country, bacterial species, type of sampling, antimicrobials, study duration and correlations between AMC and AMR were collected. The use of β-lactams was correlated with cephalosporin resistance, especially in Pseudomonas aeruginosa and Enterobacterales. Carbapenem consumption was correlated with carbapenem resistance, particularly in Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii. Fluoroquinolone use was correlated with fluoroquinolone resistance in Gram-negative bacilli and methicillin resistance in Staphylococcus aureus. Multivariate DR models highlited that AMC explained from 19 to 96% of AMR variation, with a lag time between AMC and AMR variation of 2 to 4 months. Few studies have investigated the predictive capacity of DR models, which appear to be limited. CONCLUSION Despite their statistical robustness, DR models are not widely used. They confirmed the important role of fluoroquinolones, cephalosporins and carbapenems in the emergence of AMR. However, further studies are needed to assess their predictive capacity and usefulness for ASPs.
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Affiliation(s)
- Paul Laffont-Lozes
- Department of Pharmacy, Nimes University Hospital, Nimes, France
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
| | - Romaric Larcher
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France.
- PhyMedExp, INSERM U1046, CNRS, University of Montpellier, Montpellier, France.
- Service des Maladies Infectieuses et Tropicales, Hôpital Caremeau - CHU de Nimes, 1 Place Robert Debre, Nîmes, 30000, France.
| | - Florian Salipante
- Department of Biostatistics, Epidemiology, Public Health, and Innovation in Methodology (BESPIM), University of Montpellier, Nîmes University Hospital, Nimes, France
| | - Geraldine Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, Nimes, France
- Department of Biostatistics, Epidemiology, Public Health, and Innovation in Methodology (BESPIM), University of Montpellier, Nîmes University Hospital, Nimes, France
| | - Catherine Dunyach-Remy
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Jean-Philippe Lavigne
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Albert Sotto
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Paul Loubet
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
- VBIC, INSERM U1047, University of Montpellier, Nimes, France
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Kim J, Rupasinghe R, Halev A, Huang C, Rezaei S, Clavijo MJ, Robbins RC, Martínez-López B, Liu X. Predicting antimicrobial resistance of bacterial pathogens using time series analysis. Front Microbiol 2023; 14:1160224. [PMID: 37250043 PMCID: PMC10213968 DOI: 10.3389/fmicb.2023.1160224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Antimicrobial resistance (AMR) is arguably one of the major health and economic challenges in our society. A key aspect of tackling AMR is rapid and accurate detection of the emergence and spread of AMR in food animal production, which requires routine AMR surveillance. However, AMR detection can be expensive and time-consuming considering the growth rate of the bacteria and the most commonly used analytical procedures, such as Minimum Inhibitory Concentration (MIC) testing. To mitigate this issue, we utilized machine learning to predict the future AMR burden of bacterial pathogens. We collected pathogen and antimicrobial data from >600 farms in the United States from 2010 to 2021 to generate AMR time series data. Our prediction focused on five bacterial pathogens (Escherichia coli, Streptococcus suis, Salmonella sp., Pasteurella multocida, and Bordetella bronchiseptica). We found that Seasonal Auto-Regressive Integrated Moving Average (SARIMA) outperformed five baselines, including Auto-Regressive Moving Average (ARMA) and Auto-Regressive Integrated Moving Average (ARIMA). We hope this study provides valuable tools to predict the AMR burden not only of the pathogens assessed in this study but also of other bacterial pathogens.
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Affiliation(s)
- Jeonghoon Kim
- Department of Mathematics, University of California, Davis, Davis, CA, United States
| | - Ruwini Rupasinghe
- Department of Medicine and Epidemiology, Center for Animal Disease Modeling and Surveillance (CADMS), School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Avishai Halev
- Department of Mathematics, University of California, Davis, Davis, CA, United States
| | - Chao Huang
- Department of Computer Science, University of California, Davis, Davis, CA, United States
| | - Shahbaz Rezaei
- Department of Computer Science, University of California, Davis, Davis, CA, United States
| | - Maria J. Clavijo
- Department of Veterinary Diagnostic & Production Animal Medicine (VDPAM), Iowa State University, Ames, IA, United States
| | - Rebecca C. Robbins
- R.C. Robbins Swine Consulting Services, PLLC, Amarillo, TX, United States
| | - Beatriz Martínez-López
- Department of Medicine and Epidemiology, Center for Animal Disease Modeling and Surveillance (CADMS), School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Xin Liu
- Department of Computer Science, University of California, Davis, Davis, CA, United States
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Poku E, Cooper K, Cantrell A, Harnan S, Sin MA, Zanuzdana A, Hoffmann A. Systematic review of time lag between antibiotic use and rise of resistant pathogens among hospitalized adults in Europe. JAC Antimicrob Resist 2023; 5:dlad001. [PMID: 36694849 PMCID: PMC9856344 DOI: 10.1093/jacamr/dlad001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
Background Antimicrobial resistance (AMR) causes substantial health and economic burden to individuals, healthcare systems and societies globally. Understanding the temporal relationship between antibiotic consumption and antibiotic resistance in hospitalized patients can better inform antibiotic stewardship activities and the time frame for their evaluation. Objectives This systematic review examined the temporal relationship between antibiotic use and development of antibiotic resistance for 42 pre-defined antibiotic and pathogen combinations in hospitalized adults in Europe. Methods Searches in MEDLINE, Embase, Cochrane Library and NIHR Centre for Reviews and Dissemination were undertaken from 2000 to August 2021. Pathogens of interest were Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecium, CoNS, Pseudomonas aeruginosa and Acinetobacter baumannii complex. Results Twenty-eight ecological studies and one individual-level study were included. Ecological studies were predominantly retrospective in design (19 studies) and of reasonable (20 studies) to high (8 studies) methodological quality. Of the eight pathogens of interest, no relevant data were identified for S. pneumoniae and CoNS. Across all pathogens, the time-lag data from the 28 ecological studies showed a similar pattern, with the majority of studies reporting lags ranging from 0 to 6 months. Conclusions Development of antibiotic resistance for the investigated antibiotic/pathogen combinations tends to occur over 0 to 6 months following exposure within European hospitals. This information could inform planning of antibiotic stewardship activities in hospital settings.
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Affiliation(s)
- Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Cooper
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sue Harnan
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Muna Abu Sin
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Arina Zanuzdana
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Aldeyab MA, Bond SE, Conway BR, Lee-Milner J, Sarma JB, Lattyak WJ. A Threshold Logistic Modelling Approach for Identifying Thresholds between Antibiotic Use and Methicillin-Resistant Staphylococcus aureus Incidence Rates in Hospitals. Antibiotics (Basel) 2022; 11:antibiotics11091250. [PMID: 36140029 PMCID: PMC9495804 DOI: 10.3390/antibiotics11091250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to demonstrate the utility of threshold logistic modelling, an innovative approach in identifying thresholds and risk scores in the context of population antibiotic use associated with methicillin-resistant Staphylococcus aureus (MRSA) incidence rates in hospitals. The study also aimed to assess the impact of exceeding those thresholds that resulted in increased MRSA rates. The study was undertaken in a 700-bed hospital in England between January 2015 and December 2021 (84 monthly observations). By employing the threshold logistic modelling approach, we: (i) determined the cut-off percentile value of MRSA incidence that defines a critical level of MRSA; (ii) identified thresholds for fluoroquinolone and co-amoxiclav use that would accelerate MRSA incidence rates and increase the probability of reaching critical incidence levels; (iii) enabled a better understanding of the effect of antibiotic use on the probability of reaching a critical level of resistant pathogen incidence; (iv) developed a near real-time performance monitoring feedback system; (v) provided risk scores and alert signals for antibiotic use, with the ability to inform hospital policies, and control MRSA incidence; and (vi) provided recommendations and an example for the management of pathogen incidence in hospitals. Threshold logistic models can help hospitals determine quantitative targets for antibiotic usage and can also inform effective antimicrobial stewardship to control resistance in hospitals. Studies should work toward implementing and evaluating the proposed approach prospectively, with the aim of determining the best counter-measures to mitigate the risk of increased resistant pathogen incidence in hospitals.
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Affiliation(s)
- Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
- Correspondence:
| | - Stuart E. Bond
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Jade Lee-Milner
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - Jayanta B. Sarma
- Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
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Identifying Antibiotic Use Targets for the Management of Antibiotic Resistance Using an Extended-Spectrum β-Lactamase-Producing Escherichia coli Case: A Threshold Logistic Modeling Approach. Antibiotics (Basel) 2022; 11:antibiotics11081116. [PMID: 36009985 PMCID: PMC9405284 DOI: 10.3390/antibiotics11081116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to develop a logistic modeling concept to improve understanding of the relationship between antibiotic use thresholds and the incidence of resistant pathogens. A combined approach of nonlinear modeling and logistic regression, named threshold logistic, was used to identify thresholds and risk scores in hospital-level antibiotic use associated with hospital-level incidence rates of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli). Threshold logistic models identified thresholds for fluoroquinolones (61.1 DDD/1000 occupied bed days (OBD)) and third-generation cephalosporins (9.2 DDD/1000 OBD) to control hospital ESBL-producing E. coli incidence. The 60th percentile of ESBL-producing E. coli was determined as the cutoff for defining high incidence rates. Threshold logistic analysis showed that for every one-unit increase in fluoroquinolones and third-generation cephalosporins above 61.1 and 9.2 DDD/1000 OBD levels, the average odds of the ESBL-producing E. coli incidence rate being ≥60th percentile of historical levels increased by 4.5% and 12%, respectively. Threshold logistic models estimated the risk scores of exceeding the 60th percentile of a historical ESBL-producing E. coli incidence rate. Threshold logistic models can help hospitals in defining critical levels of antibiotic use and resistant pathogen incidence and provide targets for antibiotic consumption and a near real-time performance monitoring feedback system.
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Durant DJ, Young CG. Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State. J Patient Saf 2022; 18:e508-e513. [PMID: 34009865 DOI: 10.1097/pts.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Clostridioides difficile is the most common hospital-acquired pathogen and persists in the environment for extended periods. As a common entry point for patients with diarrhea, and a setting providing fast-paced, high-volume care, emergency departments (EDs) are often sites of C. difficile contamination. This study examined the relationship between average patient wait times in the ED before admission and overall hospital-acquired C. difficile infection (HA-CDI) rates in New York State acute care hospitals. METHODS A random-effects regression analysis compared each facility's annual average ED wait time for admitted patients with that facility's average (HA-CDI) rates for patients entering through the ED. This model controlled for known clinical and nonclinical predictors of HA-CDI: average length of stay; case mix index; total discharges, a measure of hospital size; and percent Medicare discharges, a proxy for advanced age. RESULTS Emergency department wait times had a significant and positive relationship with HA-CDI rates. Facilities experience an additional 0.002 cases of HA-CDI per 1000 patient discharges with every additional minute patients spend in the ED (P = 0.003), on average. Emergency department wait times also had the largest effect size (0.210), indicating that they explain more of the variance in HA-CDI rates for patients entering through the ED than some of the best-known predictors of HA-CDI. CONCLUSIONS The relationship between ED wait times and eventual HA-CDI warrants further exploration. These findings suggest efforts to reduce ED wait times for admitted patients or more rigorous environmental cleanliness strategies in the ED, as possible avenues for HA-CDI prevention.
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Bertolino G, Marras L, Mureddu V, Camboni M, Cadeddu A. Trends of Antimicrobial Consumption in Hospital: Tackling the Hidden Part of the Iceberg with an Electronic Personalised Prescription Software for Antimicrobial Stewardship. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022. [DOI: 10.1007/5584_2022_752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Laager M, Cooper BS, Eyre DW. Probabilistic modelling of effects of antibiotics and calendar time on transmission of healthcare-associated infection. Sci Rep 2021; 11:21417. [PMID: 34725404 PMCID: PMC8560804 DOI: 10.1038/s41598-021-00748-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022] Open
Abstract
Healthcare-associated infection and antimicrobial resistance are major concerns. However, the extent to which antibiotic exposure affects transmission and detection of infections such as MRSA is unclear. Additionally, temporal trends are typically reported in terms of changes in incidence, rather than analysing underling transmission processes. We present a data-augmented Markov chain Monte Carlo approach for inferring changing transmission parameters over time, screening test sensitivity, and the effect of antibiotics on detection and transmission. We expand a basic model to allow use of typing information when inferring sources of infections. Using simulated data, we show that the algorithms are accurate, well-calibrated and able to identify antibiotic effects in sufficiently large datasets. We apply the models to study MRSA transmission in an intensive care unit in Oxford, UK with 7924 admissions over 10 years. We find that falls in MRSA incidence over time were associated with decreases in both the number of patients admitted to the ICU colonised with MRSA and in transmission rates. In our inference model, the data were not informative about the effect of antibiotics on risk of transmission or acquisition of MRSA, a consequence of the limited number of possible transmission events in the data. Our approach has potential to be applied to a range of healthcare-associated infections and settings and could be applied to study the impact of other potential risk factors for transmission. Evidence generated could be used to direct infection control interventions.
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Affiliation(s)
- Mirjam Laager
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Ben S Cooper
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Wang Y, Van Driel ML, McGuire TM, Hollingworth SA. Trends in systemic antifungal use in Australia, 2005-2016: a time-series analysis. Jpn J Infect Dis 2021; 75:254-261. [PMID: 34588371 DOI: 10.7883/yoken.jjid.2021.505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Data on antifungal utilization trends are important to encourage antifungal stewardship. This study explored the utilization of antifungal agents for systemic use and the impact of reimbursement policy changes in Australia. We analyzed national data from the Australian Pharmaceutical Benefits Scheme (PBS) (2005-2016). We examined patterns of use over time and the impact of reimbursement decisions on antifungal use with an interrupted time-series model. In 2005-2016, there has been an increase in the use of most antifungals, especially fluconazole, itraconazole and posaconazole. Ketoconazole was the most commonly dispensed systemic antifungal (46.0%) before its PBS listing removal, when it was replaced by fluconazole (69.8%). The PBS event "Fluconazole and itraconazole restrictions eased" led to increased use of fluconazole (0.025/1000 per day with no delay). Both the largest rates and numerical increase were among obstetricians and gynecologists (1,969%; 1,851 dispensed prescriptions) and dermatologists (1,723%; 1,689 dispensed prescriptions) except general practitioner (2010-2016). This is the first Australian national longitudinal estimate of systemic antifungal use. It shows an overall increase in prescribing of most antifungals during study period, with reimbursement decisions impacting utilization. These data provide a baseline to inform development of national antifungal guidelines and policies to encourage more targeted antifungal stewardship.
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Affiliation(s)
- Yan Wang
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, China.,School of Pharmacy, University of Queensland, Australia
| | - Mieke L Van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Australia
| | - Treasure M McGuire
- School of Pharmacy, University of Queensland, Australia.,Faculty of Health Sciences & Medicine, Bond University, Australia.,Mater Pharmacy, Mater Health, Australia
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Yusef D, Hayajneh WA, Bani Issa A, Haddad R, Al-Azzam S, Lattyak EA, Lattyak WJ, Gould I, Conway BR, Bond S, Conlon-Bingham G, Aldeyab MA. Impact of an antimicrobial stewardship programme on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitals in Jordan. J Antimicrob Chemother 2021; 76:516-523. [PMID: 33219679 DOI: 10.1093/jac/dkaa464] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the impact of an antimicrobial stewardship programme (ASP) on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitalized patients. METHODS The study was a retrospective, ecological assessment in a tertiary teaching hospital over 6 years (January 2014 to December 2019). The intervention involved the implementation of an ASP in February 2018, which remains in effect today. This ASP consists of several components, including education, antibiotic guidelines, antibiotic restriction policy with prior approval, audit of compliance to the restriction policy and feedback. Restricted antibiotics were imipenem/cilastatin, ertapenem, meropenem, vancomycin, teicoplanin, tigecycline, colistin, amikacin, piperacillin/tazobactam, levofloxacin and ciprofloxacin. The intervention was evaluated by time-series methods. RESULTS Statistically significant decreases in the level of antibiotic use, after the introduction of the ASP, were observed for the following antibiotics: imipenem/cilastatin (P = 0.0008), all carbapenems (P = 0.0001), vancomycin (P = 0.0006), colistin (P = 0.0016) and third-generation cephalosporins (P = 0.0004). A statistically significant decrease in the slope, after the introduction of the ASP, for ertapenem (P = 0.0044) and ciprofloxacin (P = 0.0117) was observed. For piperacillin/tazobactam, there was a significant increasing trend (P = 0.0208) before the introduction of the ASP. However, this increased trend was halted post-introduction of the ASP (P = 0.4574). The introduction of the ASP was associated with a significant impact on reducing the levels of CRAb (P = 0.0237). CONCLUSIONS The introduced antimicrobial stewardship interventions contributed to a reduction in the use of several broad-spectrum antibiotics, reversed the trends of increasing use of other antibiotics and were associated with a significant reduction in CRAb.
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Affiliation(s)
- Dawood Yusef
- Department of Paediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wail A Hayajneh
- Department of Paediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ali Bani Issa
- Infection Control Division, King Abdullah University Hospital, Irbid, Jordan
| | - Rami Haddad
- Information Technology Department, King Abdullah University Hospital, Irbid, Jordan
| | - Sayer Al-Azzam
- Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Ian Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Barbara R Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Stuart Bond
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | | | - Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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Hayajneh WA, Al-Azzam S, Yusef D, Lattyak WJ, Lattyak EA, Gould I, López-Lozano JM, Conway BR, Conlon-Bingham G, Aldeyab MA. Identification of thresholds in relationships between specific antibiotic use and carbapenem-resistant Acinetobacter baumannii (CRAb) incidence rates in hospitalized patients in Jordan. J Antimicrob Chemother 2021; 76:524-530. [PMID: 33152762 DOI: 10.1093/jac/dkaa463] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/06/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a major threat to public health worldwide. The relationship between the intensity of antibiotic use and resistance might not be linear, suggesting that there might be a threshold of antibiotic use, beyond which resistance would be triggered. OBJECTIVES To identify thresholds in antibiotic use, below which specific antibiotic classes have no significant measurable impact on the incidence of carbapenem-resistant Acinetobacter baumannii (CRAb), but above which their use correlates with an increase in the incidence of CRAb. METHODS The study took place at a tertiary teaching hospital in Jordan. The study was ecological in nature and was carried out retrospectively over the period January 2014 to December 2019. The outcome time series for this study was CRAb cases. The primary explanatory variables were monthly use of antibiotics and the use of alcohol-based hand rub (ABHR). Non-linear time-series methods were used to identify thresholds in antibiotic use. RESULTS Non-linear time-series analysis determined a threshold in third-generation cephalosporin and carbapenem use, where the maximum use of third-generation cephalosporins and carbapenems should not exceed 8 DDD/100 occupied bed days (OBD) and 10 DDD/100 OBD, respectively. ABHR had a significant reducing effect on CRAb cases even at lower usage quantities (0.92 L/100 OBD) and had the most significant effect when ABHR exceeded 3.4 L/100 OBD. CONCLUSIONS The identification of thresholds, utilizing non-linear time-series methods, can provide a valuable tool to inform hospital antibiotic policies through identifying quantitative targets that balance access to effective therapies with control of resistance. Further studies are needed to validate the identified thresholds, through being prospectively adopted as a target for antimicrobial stewardship programmes, and then to evaluate the impact on reducing CRAb incidence.
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Affiliation(s)
- Wail A Hayajneh
- Department of Paediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sayer Al-Azzam
- Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Dawood Yusef
- Department of Paediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Ian Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | | | - Barbara R Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | | | - Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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14
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Deusenbery C, Wang Y, Shukla A. Recent Innovations in Bacterial Infection Detection and Treatment. ACS Infect Dis 2021; 7:695-720. [PMID: 33733747 DOI: 10.1021/acsinfecdis.0c00890] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Bacterial infections are a major threat to human health, exacerbated by increasing antibiotic resistance. These infections can result in tremendous morbidity and mortality, emphasizing the need to identify and treat pathogenic bacteria quickly and effectively. Recent developments in detection methods have focused on electrochemical, optical, and mass-based biosensors. Advances in these systems include implementing multifunctional materials, microfluidic sampling, and portable data-processing to improve sensitivity, specificity, and ease of operation. Concurrently, advances in antibacterial treatment have largely focused on targeted and responsive delivery for both antibiotics and antibiotic alternatives. Antibiotic alternatives described here include repurposed drugs, antimicrobial peptides and polymers, nucleic acids, small molecules, living systems, and bacteriophages. Finally, closed-loop therapies are combining advances in the fields of both detection and treatment. This review provides a comprehensive summary of the current trends in detection and treatment systems for bacterial infections.
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Affiliation(s)
- Carly Deusenbery
- School of Engineering, Center for Biomedical Engineering, Institute for Molecular and Nanoscale Innovation, Brown University, Providence, Rhode Island 02912, United States
| | - Yingying Wang
- Department of Chemistry, Brown University, Providence, Rhode Island 02912, United States
| | - Anita Shukla
- School of Engineering, Center for Biomedical Engineering, Institute for Molecular and Nanoscale Innovation, Brown University, Providence, Rhode Island 02912, United States
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15
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Durant DJ. Can patient-reported room cleanliness measures predict hospital-acquired C. difficile infection? A study of acute care facilities in New York state. Am J Infect Control 2021; 49:452-457. [PMID: 32889067 DOI: 10.1016/j.ajic.2020.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patient experience measures, like those form the Hospital Consumer Assessment of Healthcare providers and Systems survey, are increasingly used in healthcare policy decisions. However, it remains unclear if these reflect quality of care, like rates of hospital-acquired infections (HAIs). This study examined the relationship between patient-reported room cleanliness, from the Hospital Consumer Assessment of Healthcare providers and Systems survey, and hospital-acquired C. difficile infection (HA-CDI) rates in NYS acute care hospitals. METHODS A random-effects regression analysis compared the percentage of patients indicating their room was "always" and "sometimes/never" kept clean to that facility's average HA-CDI rates, controlling for known predictors. RESULTS A higher percentage of patients reporting their room was "always" kept clean was associated with significantly lower rates of HA-CDI. Facilities experience 0.031 fewer cases of HA-CDI/1,000 discharges for every percentage point increase in the number of patients rating their room as "always" clean (P = .006). A higher percentage of patients reporting their room was "sometimes/never" kept clean was associated with higher rates of HA-CDI (β = 0.033), but this was not significant (P = .096). CONCLUSIONS These findings suggest patient perceptions of cleanliness may reflect microbial cleanliness and these measures could assist in the prevention of HAIs. However, further research is needed.
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16
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In vitro antagonistic inhibitory effects of palm seed crude oils and their main constituent, lauric acid, with oxacillin in Staphylococcus aureus. Sci Rep 2021; 11:177. [PMID: 33420288 PMCID: PMC7794437 DOI: 10.1038/s41598-020-80481-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022] Open
Abstract
Infections caused by Staphylococcus aureus are a serious global threat, and with the emergence of antibiotic resistance, even more difficult to treat. One of the possible complications in antistaphylococcal therapy represents negative interactions of antibiotics with food. In this study, the in vitro interaction between oxacillin and crude palm seed oil from Astrocaryum vulgare, Cocos nucifera, and Elaeis guineensis against nine strains of S. aureus was determined using the checkerboard method. Lauric acid was identified as a major constituent of all tested oils by gas chromatography. The results showed strong concentration dependent antagonistic interactions between palm oils and oxacillin with values of fractional inhibitory concentrations indices ranging from 4.02 to 8.56 at concentrations equal or higher than 1024 µg/mL of the tested oils. Similarly, lauric acid in combination with oxacillin produced antagonistic action with fractional inhibitory concentration indices ranging from 4.01 to 4.28 at 1024 µg/mL. These findings suggest that interference between oxacillin and palm oils and their constituents can negatively affect the treatment of staphylococcal infections in humans and other animals.
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17
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COVID-19 Pandemic: ARIMA and Regression Model-Based Worldwide Death Cases Predictions. ACTA ACUST UNITED AC 2020; 1:288. [PMID: 33063056 PMCID: PMC7456206 DOI: 10.1007/s42979-020-00298-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/08/2020] [Indexed: 11/19/2022]
Abstract
COVID-19 has now taken a frightening form. As the days pass, it is becoming more and more widespread and now it has become an epidemic. The death rate, which was earlier in the hundreds, changed to thousands and then progressed to millions. If the same situation persists over time, the day is not far when the humanity of all the countries on the globe will be endangered and we yearn for breath. From January 2020 till now, many scientists, researchers and doctors have been trying to solve this complex problem so that proper arrangements can be made by the governments in the hospitals and the death rate can be reduced. The presented research article shows the estimated mortality rate by the ARIMA model and the regression model. This dataset has been collected precisely from DataHub-Novel Coronavirus 2019-Dataset from 22nd January to 29th June 2020. To show the current mortality rate of the entire subject, the correlation coefficients of attributes (MAE, MSE, RMSE and MAPE) were used, where the average absolute percentage error validated the model by 99.09%. The ARIMA model is used to generate auto_arima SARIMAX results, auto_arima residual plots, ARIMA model results, and corresponding prediction plots on the training dataset. These data indicate a continuous decline in death cases. By applying a regression model, the coefficients generated by the regression model are estimated, and the actual death cases and expected death cases are compared and analyzed. It is found that the predicted mortality rate has decreased after May 2, 2020. It will help the government and doctors prepare for the forthcoming plans. Based on short-period predictions, these methods can be used to forecast the mortality rate for a long period.
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18
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Rojas P, Antoñanzas F. Policies to Reduce Antibiotic Consumption: The Impact in the Basque Country. Antibiotics (Basel) 2020; 9:antibiotics9070423. [PMID: 32707701 PMCID: PMC7400169 DOI: 10.3390/antibiotics9070423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022] Open
Abstract
In 2013, a change in copayment rate was introduced in the Basque Country (one year later than in the other regions in Spain), and improvements were made to drug packaging. In 2014, a National Program Against Bacterial Resistance (Spanish abbreviation: PRAN) was approved. The aim of this study is to analyze the impact of change to the copayment rate, the adjustment of drug packaging, and the approval of PRAN on the consumption of antibiotics. Raw monthly data on the consumption of antibiotics (costs, packages, and daily defined doses per thousand people (DID)) were collected from January 2009 to December 2018 in the Basque Country. Counterfactual and intervention analysis (Autoregressive integrated moving average (ARIMA) model) was performed for the total series, disaggregated by group of antibiotics (2019 WHO Access, Watch, and Reserve (AWaRe) Classification) and active substances with the highest cost per prescription (cefditoren and moxifloxacin), the lowest cost per prescription (doxycycline and cloxacillin), and the most prescribed active ingredients (amoxicillin, azithromycin, and levofloxacin). Introduction of copayment led to a ‘stockpiling effect’ one month before its implementation, equal to 8% in the three consumption series analyzed. Only the adjustment of drug packaging significantly reduced the number of packages dispensed (−12.19%). PRAN approval reduced consumption by 0.779 DID (−4.51%), representing a significant decrease for both ’access’ and ’watch’ group antibiotics. Despite the delay in implementing changes to copayment, there was a ‘stockpiling effect’. With the adjustment of packaging, fewer packs were prescribed but with a higher drug load and price. PRAN approval reduced both the consumption of ’access group antibiotics’ (first-line treatment) and ’watch group antibiotics’ (second-line treatment).
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19
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He P, Wu Y, Huang W, Wu X, Lv J, Liu P, Bu L, Bai Z, Chen S, Feng W, Yang Z. Characteristics of and variation in airborne ARGs among urban hospitals and adjacent urban and suburban communities: A metagenomic approach. ENVIRONMENT INTERNATIONAL 2020; 139:105625. [PMID: 32251897 DOI: 10.1016/j.envint.2020.105625] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/29/2020] [Accepted: 02/29/2020] [Indexed: 05/21/2023]
Abstract
Environmental antibiotic resistance genes (ARGs) have received much attention, while the characteristics of ARGs carried by particulate matter (PM) as a function of urban functional region are almost unknown. In this study, ARGs carried by PM2.5 and PM10 in an urban hospital, a nearby urban community and the nearest suburban community were detected using metagenomics. In total, 643 ARG subtypes belonging to 22 different ARG types were identified. The chloramphenicol exporter gene, sul1, bacA, and lnuA were the most abundant ARG subtypes in all air samples. The hospital exhibited higher ARG abundance and richness than the nearby communities. ARG profiles depended on functional region: hospital and suburban samples clustered separately, and samples from the nearby urban community interspersed among them. The representation of multidrug and quinolone resistance genes decayed with distance from the hospital to the urban community to the suburban community, indicating that hospital PM may be a hotspot for ARGs encoding proteins conferring multidrug and quinolone resistance. Airborne ARGs carried by PM in the hospital environment were more closely associated with clinically important pathogens than were those in nearby communities. In particular, carbapenemase genes, including blaNDM,blaKPC,blaIMP,blaVIM,and blaOXA-48, were discovered in hospital PM. In the suburban community, crAssphage, a human host-specific bacteriophage, was applied to predict ARG abundance and found to be enriched due to anthropogenic pollution but showed no clear evidence for ARG selection. In the hospital and the nearby urban community, the drivers of ARGs were complex. Our results highlighted that PM ARGs were closely related to human activities and revealed a potential hotspot, which could provide new evidence for further research and consequently mitigate the formation of airborne ARGs and transfer risks.
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Affiliation(s)
- Peng He
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China
| | - Yan Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China
| | - Wenzhong Huang
- School of Public Health, Sun Yat-sen University, Guangzhou 510006, Guangdong, PR China
| | - Xinwei Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China
| | - Jiayun Lv
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China
| | - Pengda Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China
| | - Li Bu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China
| | - Zhijun Bai
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China
| | - Shouyi Chen
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China
| | - Wenru Feng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China.
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, PR China.
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20
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Conlon-Bingham GM, Aldeyab M, Scott M, Kearney MP, Farren D, Gilmore F, McElnay J. Effects of Antibiotic Cycling Policy on Incidence of Healthcare-Associated MRSA and Clostridioides difficile Infection in Secondary Healthcare Settings. Emerg Infect Dis 2019; 25:52-62. [PMID: 30561306 PMCID: PMC6302607 DOI: 10.3201/eid2501.180111] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This quasi-experimental study investigated the effect of an antibiotic cycling policy based on time-series analysis of epidemiologic data, which identified antimicrobial drugs and time periods for restriction. Cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin were undertaken over a 2-year period in the intervention hospital. We used segmented regression analysis to compare the effect on the incidence of healthcare-associated Clostridioides difficile infection (HA-CDI), healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA), and new extended-spectrum β-lactamase (ESBL) isolates and on changes in resistance patterns of the HA-MRSA and ESBL organisms between the intervention and control hospitals. HA-CDI incidence did not change. HA-MRSA incidence increased significantly in the intervention hospital. The resistance of new ESBL isolates to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly in the intervention hospital; however, resistance to piperacillin/tazobactam increased after a return to the standard policy. The results question the value of antibiotic cycling to antibiotic stewardship.
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21
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Colson AR, Megiddo I, Alvarez-Uria G, Gandra S, Bedford T, Morton A, Cooke RM, Laxminarayan R. Quantifying uncertainty about future antimicrobial resistance: Comparing structured expert judgment and statistical forecasting methods. PLoS One 2019; 14:e0219190. [PMID: 31276536 PMCID: PMC6611586 DOI: 10.1371/journal.pone.0219190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/18/2019] [Indexed: 11/18/2022] Open
Abstract
The increase of multidrug resistance and resistance to last-line antibiotics is a major global public health threat. Although surveillance programs provide useful current and historical information on the scale of the problem, the future emergence and spread of antibiotic resistance is uncertain, and quantifying this uncertainty is crucial for guiding decisions about investment in antibiotics and resistance control strategies. Mathematical and statistical models capable of projecting future rates are challenged by the paucity of data and the complexity of the emergence and spread of resistance, but experts have relevant knowledge. We use the Classical Model of structured expert judgment to elicit projections with uncertainty bounds of resistance rates through 2026 for nine pathogen-antibiotic pairs in four European countries and empirically validate the assessments against data on a set of calibration questions. The performance-weighted combination of experts in France, Spain, and the United Kingdom projected that resistance for five pairs on the World Health Organization’s priority pathogens list (E. coli and K. pneumoniae resistant to third-generation cephalosporins and carbapenems and MRSA) would remain below 50% in 2026. In Italy, although upper bounds of 90% credible ranges exceed 50% resistance for some pairs, the medians suggest Italy will sustain or improve its current rates. We compare these expert projections to statistical forecasts based on historical data from the European Antimicrobial Resistance Surveillance Network (EARS-Net). Results from the statistical models differ from each other and from the judgmental forecasts in many cases. The judgmental forecasts include information from the experts about the impact of current and future shifts in infection control, antibiotic usage, and other factors that cannot be easily captured in statistical forecasts, demonstrating the potential of structured expert judgment as a tool for better understanding the uncertainty about future antibiotic resistance.
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Affiliation(s)
- Abigail R. Colson
- Department of Management Science, University of Strathclyde, Glasgow, Scotland, United Kingdom
- Center for Disease Dynamics, Economics & Policy, Washington, DC, United States of America
- * E-mail:
| | - Itamar Megiddo
- Department of Management Science, University of Strathclyde, Glasgow, Scotland, United Kingdom
- Center for Disease Dynamics, Economics & Policy, Washington, DC, United States of America
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Andhra Pradesh, India
| | - Sumanth Gandra
- Department of Management Science, University of Strathclyde, Glasgow, Scotland, United Kingdom
- Center for Disease Dynamics, Economics & Policy, Washington, DC, United States of America
| | - Tim Bedford
- Department of Management Science, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Alec Morton
- Department of Management Science, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Roger M. Cooke
- Resources for the Future, Washington, DC, United States of America
- TU Delft, Delft, The Netherlands
| | - Ramanan Laxminarayan
- Department of Management Science, University of Strathclyde, Glasgow, Scotland, United Kingdom
- Center for Disease Dynamics, Economics & Policy, Washington, DC, United States of America
- Princeton Environmental Institute, Princeton University, Princeton, New Jersey, United States of America
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22
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Karakonstantis S, Kalemaki D. Antimicrobial overuse and misuse in the community in Greece and link to antimicrobial resistance using methicillin-resistant S. aureus as an example. J Infect Public Health 2019; 12:460-464. [PMID: 30981652 DOI: 10.1016/j.jiph.2019.03.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/19/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022] Open
Abstract
Both antimicrobial consumption and antimicrobial resistance are very high in Greece, ranking among the highest of Europe. The link between antimicrobial consumption and resistance is well-known. Here, we discuss the reasons of antimicrobial overuse in Greece in the community (such as self-medication, dispersion of antibiotics by pharmacies without prescription, over-prescription by physicians, patient expectations and liability pressure) and we explore the misuse of antibiotics for common community infections. Furthermore, we discuss how such overuse/misuse can drive antimicrobial resistance, using methicillin-resistance in Staphylococcus aureus as an example. S. aureus is one of the pathogens with high rates of resistance in Greece. Comparing the rate of antimicrobial susceptibility to non-beta lactams between methicillin-resistant and methicillin-sensitive S. aureus we highlight the antibiotics that have the potential to drive methicillin-resistance through co-selection. Based on the above we identify targets for intervention in order to reduce antimicrobial overuse/misuse in the community in Greece.
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Affiliation(s)
- Stamatis Karakonstantis
- Department of Internal Medicine, General Hospital of Heraklion "Venizeleio-Pananeio", Leoforos Knossou, Heraklion, 71409, Greece.
| | - Dimitra Kalemaki
- General Medicine, University Hospital of Heraklion, Heraklion, 71410, Greece
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23
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López-Lozano JM, Lawes T, Nebot C, Beyaert A, Bertrand X, Hocquet D, Aldeyab M, Scott M, Conlon-Bingham G, Farren D, Kardos G, Fésűs A, Rodríguez-Baño J, Retamar P, Gonzalo-Jiménez N, Gould IM. A nonlinear time-series analysis approach to identify thresholds in associations between population antibiotic use and rates of resistance. Nat Microbiol 2019; 4:1160-1172. [PMID: 30962570 DOI: 10.1038/s41564-019-0410-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/13/2019] [Indexed: 11/09/2022]
Abstract
Balancing access to antibiotics with the control of antibiotic resistance is a global public health priority. At present, antibiotic stewardship is informed by a 'use it and lose it' principle, in which antibiotic use by the population is linearly related to resistance rates. However, theoretical and mathematical models suggest that use-resistance relationships are nonlinear. One explanation for this is that resistance genes are commonly associated with 'fitness costs' that impair the replication or transmissibility of the pathogen. Therefore, resistant genes and pathogens may only gain a survival advantage where antibiotic selection pressures exceed critical thresholds. These thresholds may provide quantitative targets for stewardship-optimizing the control of resistance while avoiding over-restriction of antibiotics. Here, we evaluated the generalizability of a nonlinear time-series analysis approach for identifying thresholds using historical prescribing and microbiological data from five populations in Europe. We identified minimum thresholds in temporal relationships between the use of selected antibiotics and incidence rates of carbapenem-resistant Acinetobacter baumannii (Hungary), extended-spectrum β-lactamase-producing Escherichia coli (Spain), cefepime-resistant E. coli (Spain), gentamicin-resistant Pseudomonas aeruginosa (France) and methicillin-resistant Staphylococcus aureus (Northern Ireland) in different epidemiological phases. Using routinely generated data, our approach can identify context-specific quantitative targets for rationalizing population antibiotic use and controlling resistance. Prospective intervention studies that restrict antibiotic consumption are needed to validate these thresholds.
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Affiliation(s)
| | - Timothy Lawes
- The Wellcome Trust Liverpool-Glasgow Centre for Global Health Research, Liverpool, UK.
| | - César Nebot
- Centro Universitario de la Defensa de San Javier, Murcia, Spain
| | - Arielle Beyaert
- Departamento de Métodos Cuantitativos para la Economía y la Empresa, University of Murcia, Murcia, Spain
| | - Xavier Bertrand
- Laboratoire Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France.,Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Didier Hocquet
- Laboratoire Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France.,Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Mamoon Aldeyab
- School of Pharmacy and Pharmaceutical Science, Ulster University, Coleraine, UK
| | - Michael Scott
- Pharmacy Department, Northern Health and Social Care Trust and Regional Medicines Optimisation Innovation Centre, Antrim, UK
| | - Geraldine Conlon-Bingham
- Pharmacy Department, Northern Health and Social Care Trust and Regional Medicines Optimisation Innovation Centre, Antrim, UK
| | - David Farren
- Department of Medical Microbiology, Antrim Area Hospital, Antrim, UK
| | - Gábor Kardos
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Adina Fésűs
- Clinical Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Seville, Spain.,Department of Medicine, Instituto de Biomedicina de Sevilla, University of Sevilla, Seville, Spain
| | - Pilar Retamar
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Seville, Spain.,Department of Medicine, Instituto de Biomedicina de Sevilla, University of Sevilla, Seville, Spain
| | | | - Ian M Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, UK
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24
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Shakur SM, Whitehall J, Mudgil P. Pediatric bloodstream infections in metropolitan Australia. World J Pediatr 2019; 15:161-167. [PMID: 30617937 DOI: 10.1007/s12519-018-00221-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/16/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bloodstream infections (BSIs) cause significant morbidity and mortality of children worldwide. The aim of this study was to investigate BSI in children and determine the identity of causative organism and their susceptibility patterns in a metropolitan public hospital in Australia. METHODS We retrospectively reviewed children aged 0-16 years admitted to a public hospital from January 1, 2010 to August 31, 2014 inclusive, and whose blood cultures revealed bacteraemia. Data were collected regarding patient demographics, species of bacteria isolated, antimicrobial susceptibility of these isolates, and clinical outcomes. RESULTS Out of 96 patients with BSI, 55 (57.3%) were males. The median age was 3.35 years (IQR 0.44-7.46), and there were 2 mortalities. Common sites of infection were the respiratory tract (16.6%, n = 16), bone and joints (15.6%, n = 15) and the urinary tract (11.5%, n = 11). The most frequent isolates were Staphylococcus aureus (27.0%), Escherichia coli (14.0%) and Streptococcus pneumoniae (12.0%). Whilst most bacterial isolates displayed susceptibility (> 90%) to common antimicrobial agents, only 57.1% (8/14) of Escherichia coli isolates were susceptible to ampicillin and 58.3% (7/12) were susceptible to co-trimoxazole. CONCLUSIONS Gram-positive bacteria accounted for the majority of pediatric BSIs, of which invasive pneumococcal disease remains a noteworthy cause. The majority of isolates, except Escherichia coli, were susceptible to commonly used antimicrobials. This study confirms the knowledge of high rates of resistance of Escherichia coli to ampicillin. Therefore, empirical treatment should still include gentamicin. Monitoring of resistance patterns is warranted to ensure that antibiotic therapy remains appropriate.
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Affiliation(s)
- Shakif Mohammad Shakur
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - John Whitehall
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Poonam Mudgil
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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25
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Tóth H, Fésűs A, Kungler-Gorácz O, Balázs B, Majoros L, Szarka K, Kardos G. Utilization of Vector Autoregressive and Linear Transfer Models to Follow Up the Antibiotic Resistance Spiral in Gram-negative Bacteria From Cephalosporin Consumption to Colistin Resistance. Clin Infect Dis 2018; 69:1410-1421. [DOI: 10.1093/cid/ciy1086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/13/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Increasing antibiotic resistance may reciprocally affect consumption and lead to use of broader-spectrum alternatives; a vicious cycle that may gradually limit therapeutic options. Our aim in this study was to demonstrate this vicious cycle in gram-negative bacteria and show the utility of vector autoregressive (VAR) models for time-series analysis in explanatory and dependent roles simultaneously.
Methods
Monthly drug consumption data in defined daily doses per 100 bed-days and incidence densities of gram-negative bacteria (Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Acinetobacter baumannii) resistant to cephalosporins or to carbapenems were analyzed using VAR models. These were compared to linear transfer models used earlier.
Results
In case of all gram-negative bacteria, cephalosporin consumption led to increasing cephalosporin resistance, which provoked carbapenem use and consequent carbapenem resistance and finally increased colistin consumption, exemplifying the vicious cycle. Different species were involved in different ways. For example, cephalosporin-resistant Klebsiella spp. provoked carbapenem use less than E. coli, and the association between carbapenem resistance of P. aeruginosa and colistin use was weaker than that of A. baumannii. Colistin use led to decreased carbapenem use and decreased carbapenem resistance of P. aeruginosa but not of A. baumannii.
Conclusions
VAR models allow analysis of consumption and resistance series in a bidirectional manner. The reconstructed resistance spiral involved cephalosporin use augmenting cephalosporin resistance primarily in E. coli. This led to increased carbapenem use, provoking spread of carbapenem-resistant A. baumannii and consequent colistin use. Emergence of panresistance is fueled by such antibiotic-resistance spirals.
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Affiliation(s)
- Hajnalka Tóth
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - Adina Fésűs
- Department of Medical Microbiology, Faculty of Medicine, Hungary
- Clinical Pharmacy, Faculty of Pharmacy, Clinical Center, University of Debrecen, Hungary
| | - Orsolya Kungler-Gorácz
- Department of Medical Microbiology, Faculty of Medicine, Hungary
- Clinical Pharmacy, Faculty of Pharmacy, Clinical Center, University of Debrecen, Hungary
| | - Bence Balázs
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - László Majoros
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - Krisztina Szarka
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - Gábor Kardos
- Department of Medical Microbiology, Faculty of Medicine, Hungary
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Welch S, Shivam A, Duffy M. Factors influencing ceftriaxone prescribing in an emergency department. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Susan Welch
- Pharmacy Department; St Vincent's Hospital; Sydney Australia
- Faculty of Pharmacy; University of Sydney; Sydney Australia
| | - Aruna Shivam
- Emergency Department; St Vincent's Hospital; Sydney Australia
| | - Martin Duffy
- Emergency Department; St Vincent's Hospital; Sydney Australia
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Serafin MB, Hörner R. Drug repositioning, a new alternative in infectious diseases. Braz J Infect Dis 2018; 22:252-256. [PMID: 29963991 PMCID: PMC9425657 DOI: 10.1016/j.bjid.2018.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Marissa Bolson Serafin
- Universidade Federal de Santa Maria, Programa de Pós-graduacão em Ciências Farmacêuticas, Santa Maria,RS, Brazil
| | - Rosmari Hörner
- Universidade Federal de Santa Maria, Programa de Pós-graduacão em Ciências Farmacêuticas, Santa Maria,RS, Brazil; UniversidadeSanta Maria, Departamento de Análises Clínicas e Toxicológicas, Santa Maria, RS, Brazil.
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28
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Schmidt VM, Pinchbeck G, Nuttall T, Shaw S, McIntyre KM, McEwan N, Dawson S, Williams NJ. Impact of systemic antimicrobial therapy on mucosal staphylococci in a population of dogs in Northwest England. Vet Dermatol 2018; 29:192-e70. [PMID: 29664197 DOI: 10.1111/vde.12538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antimicrobial-resistant bacteria are increasingly isolated from veterinary patients. OBJECTIVES To determine risk factors for antimicrobial resistance (AMR) among canine mucosal staphylococci following routine antimicrobial treatment with cefalexin (CFX), clavulanate-amoxicillin (AC), cefovecin (CVN), clindamycin (CD) or a fluoroquinolone (FQ). ANIMALS Mucosal swab samples (n = 463) were collected from 127 dogs pre-treatment, immediately, and at one- and three-months post-treatment. METHODS Staphylococci were identified phenotypically and biochemically as coagulase negative (CoNS) or coagulase positive (CoPS); CoPS were speciated by nuc gene PCR. Antimicrobial susceptibility was determined using disc diffusion and mecA gene carriage by PCR. Multilevel, multivariable models examined associations between risk factors and presence/absence of CoPS, meticillin resistance (MR), multidrug-resistance (MDR) and fluoroquinolone resistance (FQR). RESULTS The percentage of samples with CoNS increased and with CoPS (including S. pseudintermedius) decreased immediately post-treatment with CFX, CVN and CD (P ≤ 0.001) and one month post-treatment with CD (P = 0.003). By three months post-treatment, there was no significant difference compared to pre-treatment samples. Immediately post-treatment with FQs there was significantly increased risk of isolating MRS (P = 0.002), MDR (P = 0.002) or FQR (P = 0.013) staphylococci and of MDR following CFX treatment (P = 0.019). The percentage of samples with AMR staphylococci declined from immediately to three months post-treatment and there was no significant difference between resistance prevalence at one or three months post-treatment for most AMR traits and treatment groups. Exceptions include increased MDR following FQ (P = 0.048) or CFX (P = 0.021), at one and three months post-treatment, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE Systemic antimicrobials impact on mucosal staphylococci. Immediately after therapy, the mucosa may be a reservoir for AMR staphylococci that are a source of mobile genetic elements carrying AMR genes.
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Affiliation(s)
- Vanessa M Schmidt
- Institute of Veterinary Science, The University of Liverpool, Leahurst Campus Chester High Road, Neston, CH64 7TE, UK.,Department of Epidemiology and Population Health, Institute of Infection and Global Health, The University of Liverpool, Leahurst Campus Chester High Road, Neston, CH64 7TE, UK
| | - Gina Pinchbeck
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, The University of Liverpool, Leahurst Campus Chester High Road, Neston, CH64 7TE, UK
| | - Tim Nuttall
- Institute of Veterinary Science, The University of Liverpool, Leahurst Campus Chester High Road, Neston, CH64 7TE, UK.,The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Bush Farm Road Easter Bush Campus, Roslin, Midlothian, UK
| | - Steve Shaw
- UK Vet Derm, 16 Talbot Street Whitwick, Coalville, LE67 5AW, Leicestershire, UK
| | - K Marie McIntyre
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, The University of Liverpool, Leahurst Campus Chester High Road, Neston, CH64 7TE, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, West Derby Street, Liverpool, L69 7BE, UK
| | - Neil McEwan
- Institute of Veterinary Science, The University of Liverpool, Leahurst Campus Chester High Road, Neston, CH64 7TE, UK
| | - Susan Dawson
- Institute of Veterinary Science, The University of Liverpool, Leahurst Campus Chester High Road, Neston, CH64 7TE, UK
| | - Nicola J Williams
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, The University of Liverpool, Leahurst Campus Chester High Road, Neston, CH64 7TE, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, West Derby Street, Liverpool, L69 7BE, UK
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Zheng W, Sun W, Simeonov A. Drug repurposing screens and synergistic drug-combinations for infectious diseases. Br J Pharmacol 2018; 175:181-191. [PMID: 28685814 PMCID: PMC5758396 DOI: 10.1111/bph.13895] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 12/12/2022] Open
Abstract
Infectious diseases account for nearly one fifth of the worldwide death toll every year. The continuous increase of drug-resistant pathogens is a big challenge for treatment of infectious diseases. In addition, outbreaks of infections and new pathogens are potential threats to public health. Lack of effective treatments for drug-resistant bacteria and recent outbreaks of Ebola and Zika viral infections have become a global public health concern. The number of newly approved antibiotics has decreased significantly in the last two decades compared with previous decades. In parallel with this, is an increase in the number of drug-resistant bacteria. For these threats and challenges to be countered, new strategies and technology platforms are critically needed. Drug repurposing has emerged as an alternative approach for rapid identification of effective therapeutics to treat the infectious diseases. For treatment of severe infections, synergistic drug combinations using approved drugs identified from drug repurposing screens is a useful option which may overcome the problem of weak activity of individual drugs. Collaborative efforts including government, academic researchers and private drug industry can facilitate the translational research to produce more effective new therapeutic agents such as narrow spectrum antibiotics against drug-resistant bacteria for these global challenges. LINKED ARTICLES This article is part of a themed section on Inventing New Therapies Without Reinventing the Wheel: The Power of Drug Repurposing. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.2/issuetoc.
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Affiliation(s)
- Wei Zheng
- National Center for Advancing Translational SciencesNational Institutes of HealthBethesdaMDUSA
| | - Wei Sun
- National Center for Advancing Translational SciencesNational Institutes of HealthBethesdaMDUSA
| | - Anton Simeonov
- National Center for Advancing Translational SciencesNational Institutes of HealthBethesdaMDUSA
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30
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Mas-Morey P, Valle M. A systematic review of inpatient antimicrobial stewardship programmes involving clinical pharmacists in small-to-medium-sized hospitals. Eur J Hosp Pharm 2017; 25:e69-e73. [PMID: 31157071 DOI: 10.1136/ejhpharm-2017-001381] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 01/22/2023] Open
Abstract
Objective Antimicrobial stewardship programmes (ASPs) have been widely implemented in large hospitals but little is known regarding small-to-medium-sized hospitals. This literature review evaluates outcomes described for ASPs participated in by clinical pharmacists and implemented in small-to-medium-sized hospitals (<500 beds). Methods Following PRISMA principles, PubMed and Cochrane Library databases were searched in early 2016 for English language articles describing implementation and outcomes for inpatient ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. Each included study was required to include at least one of the following outcomes: microbiological outcomes, quality of care and clinical outcomes or antimicrobial use and cost outcomes. Results We included 28 studies from 26 hospitals, mostly American or Canadian. Most cases (23 studies) consisted of time-series comparisons of pre-and post-intervention periods. Of the 28 studies analysed, 8 reported microbiological outcomes, 21 reported quality of care and clinical outcomes, and 27 reported antimicrobial use and cost outcomes. Interventions were not generally associated with significant changes in mortality or readmission rates but were associated with substantial cost savings, mainly due to reduced use of antibiotics or the use of cheaper antibiotics. Conclusion As far as we are aware, ours is the first systematic review that evaluates ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. ASPs appear to be an effective strategy for reducing antimicrobial use and cost. However, the limited association with better microbiological, care quality and clinical outcomes would highlight the need for further studies and for standardised methods for evaluating ASP outcomes.
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Affiliation(s)
- Pedro Mas-Morey
- Department of Pharmacy, Hospital Quirónsalud Palmaplanas, Palma de Mallorca, Balearic Islands, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Valle
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Pharmacokinetic/Pharmacodynamic Modelling and Simulation, Sant Pau Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain
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31
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Asencio Egea MÁ, Huertas Vaquero M, Carranza González R, Herráez Carrera Ó, Redondo González O, Arias Arias Á. Trend and seasonality of community-acquired Escherichia coli antimicrobial resistance and its dynamic relationship with antimicrobial use assessed by ARIMA models. Enferm Infecc Microbiol Clin 2017; 36:502-506. [PMID: 29217096 DOI: 10.1016/j.eimc.2017.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We studied the trend and seasonality of community-acquired Escherichia coli resistance and quantified its correlation with the previous use of certain antibiotics. METHODS A time series study of resistant community-acquired E. coli isolates and their association with antibiotic use was conducted in a Primary Health Care Area from 2008 to 2012. A Poisson regression model was constructed to estimate the trend and seasonality of E. coli resistance. RESULTS A significant increasing trend in mean E. coli resistance to cephalosporins, aminoglycosides and nitrofurantoin was observed. Seasonal resistance to ciprofloxacin and amoxicillin-clavulanic acid was significantly higher in autumn-winter. There was a delay of 7, 10 and 12 months between the use of cotrimoxazole (P<0.038), fosfomycin (P<0.024) and amoxicillin-clavulanic acid (P<0.015), respectively, and the occurrence of E. coli resistance. CONCLUSIONS An average delay of 10 months between the previous use of amoxicillin-clavulanic acid, cotrimoxazole and fosfomycin and the appearance of resistant community-acquired E. coli strains was detected.
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Affiliation(s)
- María Ángeles Asencio Egea
- Laboratorio de Microbiología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | - María Huertas Vaquero
- Laboratorio de Microbiología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Rafael Carranza González
- Laboratorio de Microbiología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Óscar Herráez Carrera
- Unidad de Calidad del Laboratorio, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Olga Redondo González
- Unidad de Apoyo a la Investigación, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Ángel Arias Arias
- Unidad de Apoyo a la Investigación, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
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Morris DO, Loeffler A, Davis MF, Guardabassi L, Weese JS. Recommendations for approaches to meticillin-resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures.: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. Vet Dermatol 2017; 28:304-e69. [PMID: 28516494 DOI: 10.1111/vde.12444] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multiple drug resistance (MDR) in staphylococci, including resistance to the semi-synthetic penicillinase-resistant penicillins such as meticillin, is a problem of global proportions that presents serious challenges to the successful treatment of staphylococcal infections of companion animals. OBJECTIVES The objective of this document is to provide harmonized recommendations for the diagnosis, prevention and treatment of meticillin-resistant staphylococcal infections in dogs and cats. METHODS The authors served as a Guideline Panel (GP) and reviewed the literature available prior to September 2016. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) provided guidance and oversight for this process. A draft of the document was presented at the 8th World Congress of Veterinary Dermatology (May 2016) and was then made available via the World Wide Web to the member organizations of the WAVD for a period of three months. Comments were solicited and posted to the GP electronically. Responses were incorporated by the GP into the final document. CONCLUSIONS Adherence to guidelines for the diagnosis, laboratory reporting, judicious therapy (including restriction of use policies for certain antimicrobial drugs), personal hygiene, and environmental cleaning and disinfection may help to mitigate the progressive development and dissemination of MDR staphylococci.
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Affiliation(s)
- Daniel O Morris
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St, Philadelphia, PA, 19104, USA
| | - Anette Loeffler
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA, UK
| | - Meghan F Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Luca Guardabassi
- Department of Biomedical Sciences, School of Veterinary Medicine, Ross University, Basseterre, St Kitts and Nevis, West Indies
| | - J Scott Weese
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada, N1G 2W1
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33
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Al-Maliky GR, Al-Ward MM, Taqi A, Balkhair A, Al-Zakwani I. Evaluation of antibiotic prescribing for adult inpatients at Sultan Qaboos University Hospital, Sultanate of Oman. Eur J Hosp Pharm 2017; 25:195-199. [PMID: 31157018 DOI: 10.1136/ejhpharm-2016-001146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 11/04/2022] Open
Abstract
Objective Little is known into the prudent use of antibiotics in hospitals in Oman. This study is to evaluate antibiotic prescribing by measuring the overall compliance with the local antibiotic prescribing guidelines. Methods An observational study involving 366 patients' admission episodes as determined by power analysis on patients (≥18 years) on oral and/or parenteral antibiotic during admission, in the period of 10 weeks (1 February-15 April, 2014). The adapted audit tool of the Barking, Havering and Redbridge University Hospitals NHS Trust was used for this study. Analyses were performed using descriptive statistics. Main outcome measures: antibiotic prescribing compliance with the local guidelines as well as the overall restricted antibiotic policy adherence at Sultan Qaboos University Hospital (SQUH). Results The number of prescribed and audited antibiotics totalled 825, compliance with local guidelines was suboptimal at 63% (n=520), and of 211 restricted antibiotics prescribed, the overall adherence to restricted antibiotic policy was inadequate at 46% (n=98). The majority of the antibiotics prescribed were broad spectrum at 90% (n=739), mainly penicillins at 31% (n=256) and cephalosporins at 17% (n=139). Conclusion The study has provided valuable baseline details of antibiotic prescribing patterns in SQUH. The diagnosis was documented in 89% (n=327) of the admission episodes. However, the compliance with SQUH antibiotic prescribing guidelines was suboptimal, and the overall compliance with SQUH restricted antibiotic guidelines was in 46% of the prescriptions. Further studies are required to address the reasons behind the non-compliance with local guidelines.
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Affiliation(s)
| | | | - Aqila Taqi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Al Khoudh, Oman
| | - Abdullah Balkhair
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Al Khoud, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Al Khoudh, Oman.,Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Al Khoudh, Oman
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Correlation between antibiotic consumption and resistance of bloodstream bacteria in a University Hospital in North Eastern Italy, 2008-2014. Infection 2017; 45:459-467. [PMID: 28265870 DOI: 10.1007/s15010-017-0998-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/18/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE The spread of multidrug-resistant bacteria is a worrisome problem worldwide. This study investigated the correlation between antibiotic consumption and antimicrobial resistance trends of the most important bacteria causing bacteremia at the University hospital of Trieste, Italy, from 2008 to 2014. METHODS Antibiotic consumption (Defined Daily Dose-DDD-per 100 patient/days) and antibiotic resistance (percentage of antibiotic intermediate o resistant isolates) were analyzed independently with linear correlation by year. Potential correlations between antibiotic consumption and bacteria resistance rates were investigated through the Pearson's correlation. RESULTS The overall consumption of antibiotic grew from 80 to 97 DDD 100 patient/days (p = 0.005) during the study period. The increased consumption of amoxicillin/clavulanate and piperacillin/tazobactam was associated with the reduction of MRSA rate from 48.5 to 25.9% (p = 0.007 and p = 0.04, respectively). The increased consumption of piperacillin/tazobactam was associated with the reduction of ESBL-positive Enterobacteriaceae rate from 28.9 to 20.9% (p = 0.01). The increased consumption of carbapenems was associated with the increased rate of carbapenem-resistant Acinetobacter baumannii from 0 to 96.4% (p = 0.03). No carbapenem-resistant Enterobacteriaceae isolates were reported. The consumption of vancomycin grew significantly (p = 0.005). A dramatic spread of vancomycin-resistant Enterococcus faecium occurred in 2014. The consumption of fluoroquinolones and extended-spectrum cephalosporins remained stable. CONCLUSIONS An antibiotic stewardship program targeted to limit the consumption of extended-spectrum cephalosporins and fluoroquinolones in favor of amoxicillin/clavulanate and piperacillin/tazobactam correlates with a decreasing rate of MRSA and ESBL-positive Enterobacteriaceae. The analysis of correlations between antibiotic consumption and bacterial resistance rates is a useful tool to orient antimicrobial stewardship policies at local level.
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Collineau L, Belloc C, Stärk KDC, Hémonic A, Postma M, Dewulf J, Chauvin C. Guidance on the Selection of Appropriate Indicators for Quantification of Antimicrobial Usage in Humans and Animals. Zoonoses Public Health 2016; 64:165-184. [PMID: 27592024 DOI: 10.1111/zph.12298] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 11/28/2022]
Abstract
An increasing variety of indicators of antimicrobial usage has become available in human and veterinary medicine, with no consensus on the most appropriate indicators to be used. The objective of this review is therefore to provide guidance on the selection of indicators, intended for those aiming to quantify antimicrobial usage based on sales, deliveries or reimbursement data. Depending on the study objective, different requirements apply to antimicrobial usage quantification in terms of resolution, comprehensiveness, stability over time, ability to assess exposure and comparability. If the aim is to monitor antimicrobial usage trends, it is crucial to use a robust quantification system that allows stability over time in terms of required data and provided output; to compare usage between different species or countries, comparability must be ensured between the different populations. If data are used for benchmarking, the system comprehensiveness is particularly crucial, while data collected to study the association between usage and resistance should express the exposure level and duration as a measurement of the exerted selection pressure. Antimicrobial usage is generally described as the number of technical units consumed normalized by the population at risk of being treated in a defined period. The technical units vary from number of packages to number of individuals treated daily by adding different levels of complexity such as daily dose or weight at treatment. These technical units are then related to a description of the population at risk, based either on biomass or number of individuals. Conventions and assumptions are needed for all of these calculation steps. However, there is a clear lack of standardization, resulting in poor transparency and comparability. By combining study requirements with available approaches to quantify antimicrobial usage, we provide suggestions on the most appropriate indicators and data sources to be used for a given study objective.
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Affiliation(s)
- L Collineau
- SAFOSO AG, Bern, Liebefeld, Switzerland.,BIOEPAR, INRA, Oniris, Nantes, France
| | - C Belloc
- BIOEPAR, INRA, Oniris, Nantes, France
| | | | - A Hémonic
- IFIP - French Pork and Pig Institute, Le Rheu, France
| | - M Postma
- Department of Reproduction, Obstetrics and Herd Health, Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - J Dewulf
- Department of Reproduction, Obstetrics and Herd Health, Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - C Chauvin
- Anses - French Agency for Food, Environmental and Occupational Health and Safety, Ploufragan, France
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Fuzi M. Dissimilar Fitness Associated with Resistance to Fluoroquinolones Influences Clonal Dynamics of Various Multiresistant Bacteria. Front Microbiol 2016; 7:1017. [PMID: 27458434 PMCID: PMC4935693 DOI: 10.3389/fmicb.2016.01017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/15/2016] [Indexed: 01/24/2023] Open
Abstract
Fitness cost associated with resistance to fluoroquinolones was recently shown to vary across clones of methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing Klebsiella pneumoniae. The resulting dissimilar fitness should have influenced the clonal dynamics and thereby the rates of resistance for these pathogens. Moreover, a similar mechanism was recently proposed for the emergence of the H30 and H30R lineages of ESBL-producing E. coli and the major international clone (ribotype 027) of Clostridium difficile. Furthermore, several additional international clones of various multiresistant bacteria are suspect to have been selected by an analogous process. An ability to develop favorable mutations in the gyrase and topoisomerase IV genes seems to be a prerequisite for pathogens to retain fitness while showing high-level resistance to fluoroquinolones. Since, the consumption of other "non-fluoroquinolone" groups of antibiotics have also contributed to the rise in resistance rates a more judicious use of antibiotics in general and of fluoroquinolones in particular could ameliorate the international resistance situation.
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Affiliation(s)
- Miklos Fuzi
- Institute of Medical Microbiology, Semmelweis UniversityBudapest, Hungary
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37
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Tacconelli E, Cataldo MA, Paul M, Leibovici L, Kluytmans J, Schröder W, Foschi F, De Angelis G, De Waure C, Cadeddu C, Mutters NT, Gastmeier P, Cookson B. STROBE-AMS: recommendations to optimise reporting of epidemiological studies on antimicrobial resistance and informing improvement in antimicrobial stewardship. BMJ Open 2016; 6:e010134. [PMID: 26895985 PMCID: PMC4762075 DOI: 10.1136/bmjopen-2015-010134] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore the accuracy of application of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool in epidemiological studies focused on the evaluation of the role of antibiotics in selecting resistance, and to derive and test an extension of STROBE to improve the suitability of the tool in evaluating the quality of reporting in these area. METHODS A three-step study was performed. First, a systematic review of the literature analysing the association between antimicrobial exposure and acquisition of methicillin-resistant Staphylococcus aureus and/or multidrug-resistant Acinetobacter baumannii was performed. Second, articles were reviewed according to the STROBE checklist for epidemiological studies. Third, a set of potential new items focused on antimicrobial-resistance quality indicators was derived through an expert two-round RAND-modified Delphi procedure and tested on the articles selected through the literature review. RESULTS The literature search identified 78 studies. Overall, the quality of reporting appeared to be poor in most areas. Five STROBE items, comprising statistical analysis and study objectives, were satisfactory in <25% of the studies. Informative abstract, reporting of bias, control of confounding, generalisability and description of study size were missing in more than half the articles. A set of 21 new items was developed and tested. The new items focused particularly on the study setting, antimicrobial usage indicators, and patients epidemiological and clinical characteristics. The performance of the new items in included studies was very low (<25%). CONCLUSIONS Our paper reveals that reporting in epidemiological papers analysing the association between antimicrobial usage and development of resistance is poor. The implementation of the newly developed STROBE for antimicrobial stewardship (AMS) tool should enhance appropriate study design and reporting, and therefore contribute to the improvement of evidence to be used for AMS programme development and assessment.
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Affiliation(s)
- Evelina Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
| | - Maria A Cataldo
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, 2nd Infectious Disease Division, Rome, Italy
| | - M Paul
- Department of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - L Leibovici
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Petach-Tikva, Israel
| | - Jan Kluytmans
- Amphia Hospital Breda and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, location Molengracht, Laboratory for Microbiology and Infection Control, Breda, The Netherlands
| | - Wiebke Schröder
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
| | - Federico Foschi
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
| | - Giulia De Angelis
- National Institute for Infectious Diseases “Lazzaro Spallanzani”, 2nd Infectious Disease Division, Rome, Italy
| | - Chiara De Waure
- Institute of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Cadeddu
- Institute of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Nico T Mutters
- Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Petra Gastmeier
- Institute for Hygiene and Environmental Health, Charité, Medical University Berlin, Berlin, Germany
| | - Barry Cookson
- Department of Infection and Immunity, University College London, London University, London, UK
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Conlon-Bingham G, Aldeyab M, Kearney MP, Scott MG, Baldwin N, McElnay JC. Reduction in the incidence of hospital-acquired MRSA following the introduction of a chlorine dioxide 275 ppm based disinfecting agent in a district general hospital. Eur J Hosp Pharm 2016; 23:28-32. [PMID: 31156810 DOI: 10.1136/ejhpharm-2014-000608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/12/2015] [Accepted: 07/22/2015] [Indexed: 11/04/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile are major nosocomial pathogens whose control relies on effective antimicrobial stewardship and infection control practices. This study evaluates the impact of a chlorine dioxide-based disinfectant (275 ppm) on the incidence of hospital-acquired (HA) MRSA and HA-Clostridium difficile infection (CDI) in a district general hospital. Methods This study was carried out from November 2009 to September 2013. From November 2009 to October 2011 sodium dichloroisocyanurate was used for routine environmental disinfection. In November 2011, this was changed to a chlorine dioxide 275 ppm based disinfectant. This product was introduced into the hospital in a phased manner with intensive training on its use provided to all nursing, nursing auxiliary and hotel services staff. The effect of this change on the incidence of HA-MRSA and HA-CDI was assessed using segmented regression analysis of interrupted time series. In addition, the potential cost savings as a result of this intervention were assessed. Results The HA-MRSA trend from November 2009 to October 2011 significantly increased (p=0.006). Following the introduction of the chlorine dioxide-based disinfectant there was significant decrease in the HA-MRSA trend, with the monthly incidence being reduced by 0.003 cases/100 bed days (p=0.001), equating to an average of four cases per month after 12 months of use This resulted in an annual potential cost saving of £276 000. No significant effect on the incidence of HA-CDI was observed (coefficient -0.03; p=0.873). Conclusion This study highlights the importance of effective environmental inanimate surface decontamination in controlling the spread of MRSA and the potential cost savings that can be achieved through decreasing HA-MRSA rates.
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Affiliation(s)
- Geraldine Conlon-Bingham
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.,Pharmacy and Medicines Management Centre, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Mamoon Aldeyab
- Pharmacy and Medicines Management Centre, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Mary P Kearney
- Area Microbiology Laboratory, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Michael G Scott
- Pharmacy and Medicines Management Centre, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Naomi Baldwin
- Area Microbiology Laboratory, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Effects of national antibiotic stewardship and infection control strategies on hospital-associated and community-associated meticillin-resistant Staphylococcus aureus infections across a region of Scotland: a non-linear time-series study. THE LANCET. INFECTIOUS DISEASES 2015; 15:1438-49. [DOI: 10.1016/s1473-3099(15)00315-1] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/05/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
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Moxnes JF, Moen AEF, Leegaard TM. Studying the time trend of Methicillin-resistant Staphylococcus aureus (MRSA) in Norway by use of non-stationary γ-Poisson distributions. BMJ Open 2015; 5:e007163. [PMID: 26438133 PMCID: PMC4606436 DOI: 10.1136/bmjopen-2014-007163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Study the time development of methicillin-resistant Staphylococcus aureus (MRSA) and forecast future behaviour. The major question: Is the number of MRSA isolates in Norway increasing and will it continue to increase? DESIGN Time trend analysis using non-stationary γ-Poisson distributions. SETTING Two data sets were analysed. The first data set (data set I) consists of all MRSA isolates collected in Oslo County from 1997 to 2010; the study area includes the Norwegian capital of Oslo and nearby surrounding areas, covering approximately 11% of the Norwegian population. The second data set (data set II) consists of all MRSA isolates collected in Health Region East from 2002 to 2011. Health Region East consists of Oslo County and four neighbouring counties, and is the most populated area of Norway. PARTICIPANTS Both data sets I and II consist of all persons in the area and time period described in the Settings, from whom MRSA have been isolated. PRIMARY AND SECONDARY OUTCOME MEASURES MRSA infections have been mandatory notifiable in Norway since 1995, and MRSA colonisation since 2004. In the time period studied, all bacterial samples in Norway have been sent to a medical microbiological laboratory at the regional hospital for testing. In collaboration with the regional hospitals in five counties, we have collected all MRSA findings in the South-Eastern part of Norway over long time periods. RESULTS On an average, a linear or exponential increase in MRSA numbers was observed in the data sets. A Poisson process with increasing intensity did not capture the dispersion of the time series, but a γ-Poisson process showed good agreement and captured the overdispersion. The numerical model showed numerical internal consistency. CONCLUSIONS In the present study, we find that the number of MRSA isolates is increasing in the most populated area of Norway during the time period studied. We also forecast a continuous increase until the year 2017.
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Affiliation(s)
- John F Moxnes
- Protection and Social Security Division, Norwegian Defence Research Establishment, Kjeller, Norway
| | - Aina E Fossum Moen
- Section of Clinical Molecular Biology (EpiGen), Division of Medicine, Akershus University Hospital and University of Oslo, Lørenskog, Norway
| | - Truls Michael Leegaard
- Department of Microbiology and Health Control, Division of Technology, Akershus University Hospital and University of Oslo, Lørenskog, Norway
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Quinn MM, Henneberger PK, Braun B, Delclos GL, Fagan K, Huang V, Knaack JL, Kusek L, Lee SJ, Le Moual N, Maher KA, McCrone SH, Mitchell AH, Pechter E, Rosenman K, Sehulster L, Stephens AC, Wilburn S, Zock JP. Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention. Am J Infect Control 2015; 43:424-34. [PMID: 25792102 DOI: 10.1016/j.ajic.2015.01.029] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel. METHODS The Working Group, comprised of >40 members from 4 countries, reviewed current knowledge and identified knowledge gaps and future needs for research and practice. RESULTS An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention. Gaps in basic knowledge and practice that are barriers to an integrated approach were grouped in 2 broad areas related to the need for improved understanding of the (1) effectiveness of environmental surface C&D to reduce the incidence of infectious diseases and colonization in health care workers and patients and (2) adverse health impacts of C&D on health care workers and patients. Specific needs identified within each area relate to basic knowledge, improved selection and use of products and practices, effective hazard communication and training, and safer alternatives. CONCLUSION A more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C&D in health care.
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Lawes T, López-Lozano JM, Nebot C, Macartney G, Subbarao-Sharma R, Dare CRJ, Edwards GFS, Gould IM. Turning the tide or riding the waves? Impacts of antibiotic stewardship and infection control on MRSA strain dynamics in a Scottish region over 16 years: non-linear time series analysis. BMJ Open 2015; 5:e006596. [PMID: 25814495 PMCID: PMC4386222 DOI: 10.1136/bmjopen-2014-006596] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To explore temporal associations between planned antibiotic stewardship and infection control interventions and the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA). DESIGN Retrospective ecological study and time-series analysis integrating typing data from the Scottish MRSA reference laboratory. SETTING Regional hospital and primary care in a Scottish Health Board. PARTICIPANTS General adult (N=1,051,993) or intensive care (18,235) admissions and primary care registrations (460,000 inhabitants) between January 1997 and December 2012. INTERVENTIONS Hand-hygiene campaign; MRSA admission screening; antibiotic stewardship limiting use of macrolides and '4Cs' (cephalosporins, coamoxiclav, clindamycin and fluoroquinolones). OUTCOME MEASURES Prevalence density of MRSA clonal complexes CC22, CC30 and CC5/Other in hospital (isolates/1000 occupied bed days, OBDs) and community (isolates/10,000 inhabitant-days). RESULTS 67% of all clinical MRSA isolates (10,707/15,947) were typed. Regional MRSA population structure was dominated by hospital epidemic strains CC30, CC22 and CC45. Following declines in overall MRSA prevalence density, CC5 and other strains of community origin became increasingly important. Reductions in use of '4Cs' and macrolides anticipated declines in sublineages with higher levels of associated resistances. In multivariate time-series models (R(2)=0.63-0.94) introduction of the hand-hygiene campaign, reductions in mean length of stay (when >4 days) and bed occupancy (when >74 to 78%) predicted declines in CC22 and CC30, but not CC5/other strains. Lower importation pressures, expanded MRSA admission screening, and reductions in macrolide and third generation cephalosporin use (thresholds for association: 135-141, and 48-81 defined daily doses/1000 OBDs, respectively) were followed by declines in all clonal complexes. Strain-specific associations with fluoroquinolones and clindamycin reflected resistance phenotypes of clonal complexes. CONCLUSIONS Infection control measures and changes in population antibiotic use were important predictors of MRSA strain dynamics in our region. Strategies to control MRSA should consider thresholds for effects and strain-specific impacts.
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Affiliation(s)
- Timothy Lawes
- Department of Paediatrics, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | | | - César Nebot
- Centro Universitario de la Defensa (CUD) de San Javier, Murcia, Murcia, Spain
| | | | | | - Ceri R J Dare
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Ian M Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, UK
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dos Santos RP, Magedanz L, Siliprandi EMO. Antimicrobial Stewardship Programs Must Apply to All. Infect Control Hosp Epidemiol 2015; 30:205-7. [DOI: 10.1086/593209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Füzi M. Has the use of fluoroquinolones facilitated the widespread dissemination of methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the healthcare setting? Acta Microbiol Immunol Hung 2014; 61:399-405. [PMID: 25361527 DOI: 10.1556/amicr.61.2014.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Our group recently demonstrated that diverse fitness cost associated with resistance to fluoroquinolones allowed the extensive dissemination of the major international clones of both methicillin-resistant Staphylococcus aureus (MRSA) and multiresistant Klebsiella pneumoniae in the healthcare setting. The mechanism described by us was subsequently confirmed by British authors investigating the dynamics of MRSA clones in England. Our results imply that the use of fluoroquinolones should impact the incidence for both MRSA and multiresistant K. pneumoniae. A review of the related clinical studies mostly support this notion and shows that changes in the consumption of fluoroquinolone type antibiotics and the rates for both MRSA and multiresistant ESBL-producing K. pneumoniae remain usually in accordance. Though the association seems strong and the mechanism behind it unequivocal the use of fluoroquinolones should not be abandoned; a more judicious application can be recommended.
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Affiliation(s)
- Miklós Füzi
- 1 Semmelweis University Institute of Medical Microbiology Budapest Hungary
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Lee C, Walker SAN, Daneman N, Elligsen M, Palmay L, Coburn B, Simor A. Point prevalence survey of antimicrobial utilization in a Canadian tertiary-care teaching hospital. J Epidemiol Glob Health 2014; 5:143-50. [PMID: 25922323 PMCID: PMC7320490 DOI: 10.1016/j.jegh.2014.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives: Inappropriate antimicrobial use can promote antimicrobial resistance, which is associated with increased patient morbidity and mortality. Identifying the pattern of antimicrobial use can provide data from which targeted antimicrobial stewardship interventions can be made. The primary objective was to identify the prevalence of antimicrobial use at a tertiary care teaching hospital with both acute and long-term care patients. Methods: A point prevalence study was conducted on July 19th, 2012. Data on antimicrobial utilization, indication for prescribing, duration of therapy, and frequency of infectious disease or antimicrobial stewardship consultations were collected using a customized integrated stewardship database (SPIRIT) and prospective chart review. Results: One or more antimicrobial agents were ordered in 31% and 4% of acute care and long-term care patients, respectively. Respiratory and urinary tract infections were the most common indication for antimicrobial therapy in both acute and long-term care. About 25% of surgical prophylaxis orders were prescribed for greater than 24 h. Conclusion: This prospective point prevalence survey provided important baseline information on antimicrobial use within a large tertiary care teaching hospital and identified potential targets for future antimicrobial stewardship initiatives. A multi-center point prevalence survey should be considered to identify patterns of antimicrobial use in Canada and to establish the first steps toward international antimicrobial surveillance.
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Affiliation(s)
- Colin Lee
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Leslie L. Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Sandra A N Walker
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Leslie L. Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nick Daneman
- Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Marion Elligsen
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Palmay
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bryan Coburn
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Simor
- Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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46
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Hughes D. Selection and evolution of resistance to antimicrobial drugs. IUBMB Life 2014; 66:521-9. [PMID: 24933583 DOI: 10.1002/iub.1278] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 05/21/2014] [Indexed: 01/22/2023]
Abstract
The overuse and misuse of antibiotics over many years has selected a high frequency of resistance among medically important bacterial pathogens. The evolution of resistance is complex, frequently involving multiple genetic alterations that minimize biological fitness costs and/or increase the resistance level. Resistance is selected at very low drug concentrations, such as found widely distributed in the environment, and this selects for resistant mutants with a high fitness. Once resistance with high fitness is established in a community it is very difficult to reduce its frequency. Addressing the problem of resistance is essential if we are to ensure a future where we can continue to enjoy effective medical control of bacterial infections. This will require several actions including the discovery and development of novel antibiotics, the creation of a continuous pipeline of drug discovery, and the implementation of effective global antibiotic stewardship to reduce the misuse of antibiotics and their release into the environment.
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Affiliation(s)
- Diarmaid Hughes
- Department of Medical Biochemistry and Microbiology, Biomedical Center, Uppsala University, Uppsala, Sweden
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Mitchell BG, Digney W, Locket P, Dancer SJ. Controlling methicillin-resistant Staphylococcus aureus (MRSA) in a hospital and the role of hydrogen peroxide decontamination: an interrupted time series analysis. BMJ Open 2014; 4:e004522. [PMID: 24747791 PMCID: PMC3996814 DOI: 10.1136/bmjopen-2013-004522] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The impact of surface disinfection versus detergent cleaning on healthcare associated infection rates remains unresolved. We aimed to evaluate the efficacy of hydrogen peroxide (HP) decontamination against methicillin-resistant Staphylococcus aureus (MRSA). DESIGN Single centred retrospective before and after study design. SETTING Launceston General Hospital, Tasmania, Australia. PARTICIPANTS Patients with MRSA infection or colonisation. INTERVENTIONS Rooms occupied by patients with MRSA infection or colonisation were cleaned following discharge with either detergent or HP. MAIN OUTCOME MEASURES MRSA room contamination following cleaning; new MRSA acquisition in patients. RESULTS Over 3600 discharge cleans were completed, with more than 32 600 environmental swabs processed. MRSA was isolated from 24.7% rooms following detergent cleaning and from 18.8% of rooms after HP (p<0.001). The incidence of MRSA acquisition reduced from 9.0 to 5.3 per 10 000 patient days in detergent and disinfectant arms, respectively (p<0.001). CONCLUSIONS Use of HP disinfection led to a decrease in residual MRSA contamination in patient rooms compared with detergent. It may also have encouraged the reduction in patient MRSA acquisition despite several confounders including staff feedback on terminal cleaning, additional MRSA screening and quicker laboratory methods. Infection control is best served by concurrent interventions targeting both the patient and healthcare environment.
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Affiliation(s)
- Brett G Mitchell
- Faculty of Nursing and Health, Avondale College of Higher Education, New South Wales, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Dickson, Australian Capital Territory, Australia
| | | | - Phil Locket
- Launceston General Hospital, Launceston, Tasmania, Australia
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Borde JP, Kaier K, Steib-Bauert M, Vach W, Geibel-Zehender A, Busch H, Bertz H, Hug M, de With K, Kern WV. Feasibility and impact of an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a tertiary care university medical center. BMC Infect Dis 2014; 14:201. [PMID: 24731220 PMCID: PMC3999502 DOI: 10.1186/1471-2334-14-201] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Restricted use of third-generation cephalosporins and fluoroquinolones has been linked to a reduced incidence of hospital-acquired infections with multidrug-resistant bacteria. We implemented an intensified antibiotic stewardship (ABS) programme in the medical service of a university hospital center aiming at a reduction by at least 30% in the use of these two drug classes. METHODS The ABS programme was focused on the 300-bed medical service. Prescription of third-generation cephalosporins was discouraged, whereas the use of penicillins was encouraged. Monthly drug use density was measured in WHO-ATC defined and locally recommended daily doses (DDD and RDD) per 100 patient days, to evaluate trends before (01/2008 to 10/2011) and after starting the intervention (1/2012 to 3/2013). The effect was analysed using interrupted time-series analysis with six non-intervention departments as controls. RESULTS Following initiation of the ABS intervention, overall antibiotic use in the medical service declined (p < 0.001). There was a significant intervention-related decrease in the use of cephalosporins and fluoroquinolones (p < 0.001) outperforming the decreasing baseline trend. Trend changes observed in some of the control departments were smaller, and the difference between trend changes in the medical service and those in control departments were highly significant for overall use and cephalosporin use reductions (p < 0.001) as well as for the increasing use of penicillins (p < 0.001). Mean use density levels (in RDD per 100 patient days) dropped for cephalosporins from 16.3 to 10.3 (-37%) and for fluoroquinolones from 17.7 to 10.1 (-43%), respectively. During the same period, the use of penicillins increased (15.4 to 18.2; 18%). The changes in expenditures for antibiotics in the medical service compared to control services minus programme costs indicated initial net cost savings likely to be associated with the programme. CONCLUSION An intensified ABS programme targeting cephalosporin und fluoroquinolone use in the setting of a large academic hospital is feasible and effective. The intervention may serve as a model for other services and hospitals with a similar structure and baseline situation.
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Affiliation(s)
- Johannes P Borde
- Department of Medicine, Abteilung Infektiologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, D-79106 Freiburg i,Br, Germany.
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Spatial and temporal analyses to investigate infectious disease transmission within healthcare settings. J Hosp Infect 2014; 86:227-43. [PMID: 24650720 PMCID: PMC7133762 DOI: 10.1016/j.jhin.2014.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/28/2014] [Indexed: 02/08/2023]
Abstract
Background Healthcare-associated infections (HCAIs) cause significant morbidity and mortality worldwide, and outbreaks are often only identified after they reach high levels. A wide range of data is collected within healthcare settings; however, the extent to which this information is used to understand HCAI dynamics has not been quantified. Aim To examine the use of spatiotemporal analyses to identify and prevent HCAI transmission in healthcare settings, and to provide recommendations for expanding the use of these techniques. Methods A systematic review of the literature was undertaken, focusing on spatiotemporal examination of infectious diseases in healthcare settings. Abstracts and full-text articles were reviewed independently by two authors to determine inclusion. Findings In total, 146 studies met the inclusion criteria. There was considerable variation in the use of data, with surprisingly few studies (N = 22) using spatiotemporal-specific analyses to extend knowledge of HCAI transmission dynamics. The remaining 124 studies were descriptive. A modest increase in the application of statistical analyses has occurred in recent years. Conclusion The incorporation of spatiotemporal analysis has been limited in healthcare settings, with only 15% of studies including any such analysis. Analytical studies provided greater data on transmission dynamics and effective control interventions than studies without spatiotemporal analyses. This indicates the need for greater integration of spatiotemporal techniques into HCAI investigations, as even simple analyses provide significant improvements in the understanding of prevention over simple descriptive summaries.
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Maripuu H, Aldeyab MA, Kearney MP, McElnay JC, Conlon G, Magee FA, Scott MG. An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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