Abstract
Objectives: To evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital Clostridium difficile infection (CDI) incidence rates. A secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool. Methods: This was an interventional, retrospective, ecological investigation in a medium-sized hospital over 6.5 years (January 2004 to June 2010). The intervention was the restriction of high-risk antibiotics (second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and clindamycin). Amoxicillin/clavulanic acid and macrolides were classified as medium-risk antibiotics based on time-series analysis findings and their use was monitored. The intervention was evaluated by segmented regression analysis of interrupted time series. Results: The intervention was associated with a significant change in level of use of high-risk antibiotics (coefficient -17.3, P<0.0001) and with a borderline significant trend change in their use being reduced by 0.156 defined daily doses/100 bed-days per month (P=0.0597). The reduction in the use of high-risk antibiotics was associated with a significant change in the incidence trend of CDI (P=0.0081), i.e. the CDI incidence rate decreased by 0.0047/100 bed-days per month. Analysis showed that variations in the incidence of CDI were affected by the age-adjusted comorbidity index with a lag of 1 month (coefficient 0.137051, P=0.0182). Significant decreases in slope (coefficient -0.414, P=.0309) post-intervention were also observed for the monitored medium-risk antibiotics. Conclusions: The restriction of the high-risk antibiotics contributed to both a reduction in their use and a reduction in the incidence of CDI in the study site hospital. Time-series analysis can be utilized as a risk classification tool with utility in antibiotic stewardship design and quality improvement programmes. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
| Original language | English |
|---|---|
| Pages (from-to) | 2988-2996 |
| Number of pages | 8 |
| Journal | Journal of Antimicrobial Chemotherapy |
| Volume | 67 |
| Issue number | 12 |
| Early online date | 16 Aug 2012 |
| DOIs | |
| Publication status | Published (in print/issue) - 1 Dec 2012 |
Bibliographical note
Cited By :74Export Date: 15 September 2018
CODEN: JACHD
Correspondence Address: Aldeyab, M.A.; Clinical and Practice Research Group, School of Pharmacy, Queens University Belfast, BT9 7BL Belfast, Northern Ireland, United Kingdom; email: [email protected]
Chemicals/CAS: amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; clindamycin, 18323-44-9; Anti-Bacterial Agents
Funding details: DSR, KFU, Deanship of Scientific Research, King Faisal University
Funding details: DSR, Department of Sport and Recreation, Government of Western Australia
Funding details: 7-968-D1432, KAU, King Abdulaziz University
Funding text: Work by Motasem A. Aldiab was thankfully funded by the Deanship of Scientific Research (DSR), King Abdulaziz University, Jeddah, under grant no. 7-968-D1432. The study was carried out as part of the routine work of the remaining authors.
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Keywords
- C. difficile infection
- Quality improvement
- Risk classification
- Time-series analysis
- amoxicillin plus clavulanic acid
- cephalosporin derivative
- clindamycin
- macrolide
- quinolone derivative
- antiinfective agent
- antibiotic therapy
- article
- Clostridium difficile infection
- comorbidity
- drug utilization
- hospital policy
- human
- incidence
- major clinical study
- medication therapy management
- patient compliance
- retrospective study
- Clostridium difficile
- Clostridium infection
- cross infection
- diarrhea
- hospital
- isolation and purification
- microbiology
- standard
- statistics
- Anti-Bacterial Agents
- Clostridium Infections
- Cross Infection
- Diarrhea
- Drug Utilization
- Hospitals
- Humans
- Incidence
- Retrospective Studies
