An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings

M.A. Aldeyab, M.P. Kearney, M.G. Scott, M.A. Aldiab, Y.M. Alahmadi, F.W. Darwish Elhajji, F.A. Magee, J.C. McElnay

Research output: Contribution to journalArticle

86 Citations (Scopus)

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.
LanguageEnglish
Pages2988-2996
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume67
Issue number12
Early online date16 Aug 2012
DOIs
Publication statusPublished - 1 Dec 2012

Fingerprint

Clostridium Infections
Clostridium difficile
Anti-Bacterial Agents
Incidence
Cephalosporins
Amoxicillin-Potassium Clavulanate Combination
Clindamycin
Fluoroquinolones
Macrolides
Quality Improvement
Comorbidity
Regression Analysis

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

Cite this

Aldeyab, M.A. ; Kearney, M.P. ; Scott, M.G. ; Aldiab, M.A. ; Alahmadi, Y.M. ; Darwish Elhajji, F.W. ; Magee, F.A. ; McElnay, J.C. / An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. In: Journal of Antimicrobial Chemotherapy. 2012 ; Vol. 67, No. 12. pp. 2988-2996.
@article{93e2686ff7c74c57ab571412fc5f632c,
title = "An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings",
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. {\circledC} The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.",
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",
author = "M.A. Aldeyab and M.P. Kearney and M.G. Scott and M.A. Aldiab and Y.M. Alahmadi and {Darwish Elhajji}, F.W. and F.A. Magee and J.C. McElnay",
note = "Cited By :74 Export 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: maldeyab02@qub.ac.uk 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. References: Andersson, D.I., Hughes, D., Antibiotic resistance and its cost: is it possible to reverse resistance? (2010) Nat Rev Microbiol, 8, pp. 260-271; Gould, I.M., The epidemiology of antibiotic resistance (2008) Int J Antimicrob Agents, 32 Suppl 1, pp. S2-S9; Fishman, N., Antimicrobial stewardship (2006) Am J Med, 119 Suppl 1, pp. S53-S61; Dellit, T.H., Owens, R.C., McGowan Jr., J.E., Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship (2007) Clin Infect Dis, 44, pp. 159-177; Lesprit, P., Brun-Buisson, C., Hospital antibiotic stewardship (2008) Curr Opin Infect Dis, 21, pp. 344-349; Davey, P., Brown, E., Fenelon, L., Interventions to improve antibiotic prescribing practices for hospital inpatients (2005) Cochrane Database Syst Rev, (4), pp. CD003543; MacDougall, C., Polk, R.E., Antimicrobial stewardship programs in health care systems (2005) Clin Microbiol Rev, 18, pp. 638-656; Ohl, C.A., Luther, V.P., Antimicrobial stewardship for inpatient facilities (2011) Hosp Med, 6 Suppl 1, pp. S4-S15; Aldeyab, M.A., Devine, M.J., Flanagan, P., Multihospital outbreak of Clostridium difficile ribotype 027 infection: epidemiology and analysis of control measures (2011) Infect Control Hosp Epidemiol, 32, pp. 210-219; Owens Jr., R.C., Donskey, C.J., Gaynes, R.P., Antimicrobial-associated risk factors for Clostridium difficile infection (2008) Clin Infect Dis, 46 Suppl 1, pp. S19-S31; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; Shardell, M., Harris, A.D., El-Kamary, S.S., Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies (2007) Clin Infect Dis, 45, pp. 901-907; Lopez-Lozano, J.M., Monnet, D.L., Yague, A., Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis (2000) Int J Antimicrob Agents, 14, pp. 21-31; Helfenstein, U., Box-Jenkins modelling in medical research (1996) Stat Methods Med Res, 5, pp. 3-22; Aldeyab, M.A., Monnet, D.L., L{\'o}pez-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: a time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Lewis, S.J., Heaton, K.W., Stool form scale as a useful guide to intestinal transit time (1997) Scand J Gastroenterol, 32, pp. 920-924; Guidelines for ATC Classification and DDD Assignment, 2012 (2011), WHO Collaborating Centre for Drug Statistics Methodology. Oslo; Tobacman, J.K., Assessment of comorbidity: a review (1994) Clin Perform Qual Health Care, 2, pp. 23-32; Conlon, G., Aldeyab, M.A., McElnay, J.C., Improving and maintaining adherence with hospital antibiotic policies: a strategy for success (2011) J Hosp Infect, 77, pp. 88-89; Wagner, A.K., Soumerai, S.B., Zhang, F., Segmented regression analysis of interrupted time series studies in medication use research (2002) J Clin Pharm Ther, 27, pp. 299-309; Talpaert, M.J., Gopal Rao, G., Cooper, B.S., Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection (2011) J Antimicrob Chemother, 66, pp. 2168-2174; Valiquette, L., Cossette, B., Garant, M.P., Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain (2007) Clin Infect Dis, 45 Suppl 2, pp. S112-S121; Baxter, R., Ray, G.T., Fireman, B.H., Case-control study of antibiotic use and subsequent Clostridium difficile-associated diarrhea in hospitalized patients (2008) Infect Control Hosp Epidemiol, 29, pp. 44-50; Starr, J.M., Martin, H., McCoubrey, J., Risk factors for Clostridium difficile colonisation and toxin production (2003) Age Ageing, 32, pp. 657-660; P{\'e}pin, J., Saheb, N., Coulombe, M.A., Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec (2005) Clin Infect Dis, 41, pp. 1254-1260; McCusker, M.E., Harris, A.D., Perencevich, E., Fluoroquinolone use and Clostridium difficile-associated diarrhea (2003) Emerg Infect Dis, 9, pp. 730-733; Braegger, C.P., Nadal, D., Clarithromycin and pseudomembranous enterocolitis (1994) Lancet, 343, pp. 241-242; Guyot, A., Rawlins, M.D., Barrett, S.P., Clarithromycin appears to be linked with Clostridium difficile-associated diarrhoea in the elderly (2000) J Antimicrob Chemother, 46, pp. 642-643; McGowan Jr., J.E., Antimicrobial resistance in hospital organisms and its relation to antibiotic use (1983) Rev Infect Dis, 5, pp. 1033-1048; Aldeyab, M.A., Harbarth, S., Vernaz, N., The impact of antibiotic use on the incidence and resistance pattern of ESBL-producing bacteria in primary and secondary healthcare settings (2012) Br J Clin Pharmacol, 74, pp. 171-179; Monnet, D.L., MacKenzie, F.M., L{\'o}pez-Lozano, J.M., Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000 (2004) Emerg Infect Dis, 10, pp. 1432-1441; Monnet, D.L., L{\'o}pez-Lozano, J.M., Campillos, P., Making sense of antimicrobial use and resistance surveillance data: application of ARIMA and transfer function models (2001) Clin Microbiol Infect, 7 Suppl 5, pp. 29-36; Kaier, K., Hagist, C., Frank, U., Two time-series analyses of the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection (2009) Infect Control Hosp Epidemiol, 30, pp. 346-353; Gallini, A., Degris, E., Desplas, M., Influence of fluoroquinolone consumption in inpatients and outpatients on ciprofloxacin-resistant Escherichia coli in a university hospital (2010) J Antimicrob Chemother, 65, pp. 2650-2657; Vernaz, N., Huttner, B., Muscionico, D., Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community (2011) J Antimicrob Chemother, 66, pp. 928-935",
year = "2012",
month = "12",
day = "1",
doi = "10.1093/jac/dks330",
language = "English",
volume = "67",
pages = "2988--2996",
journal = "Journal of Antimicrobial Chemotherapy",
issn = "0305-7453",
number = "12",

}

An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. / Aldeyab, M.A.; Kearney, M.P.; Scott, M.G.; Aldiab, M.A.; Alahmadi, Y.M.; Darwish Elhajji, F.W.; Magee, F.A.; McElnay, J.C.

In: Journal of Antimicrobial Chemotherapy, Vol. 67, No. 12, 01.12.2012, p. 2988-2996.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings

AU - Aldeyab, M.A.

AU - Kearney, M.P.

AU - Scott, M.G.

AU - Aldiab, M.A.

AU - Alahmadi, Y.M.

AU - Darwish Elhajji, F.W.

AU - Magee, F.A.

AU - McElnay, J.C.

N1 - Cited By :74 Export 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: maldeyab02@qub.ac.uk 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. References: Andersson, D.I., Hughes, D., Antibiotic resistance and its cost: is it possible to reverse resistance? (2010) Nat Rev Microbiol, 8, pp. 260-271; Gould, I.M., The epidemiology of antibiotic resistance (2008) Int J Antimicrob Agents, 32 Suppl 1, pp. S2-S9; Fishman, N., Antimicrobial stewardship (2006) Am J Med, 119 Suppl 1, pp. S53-S61; Dellit, T.H., Owens, R.C., McGowan Jr., J.E., Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship (2007) Clin Infect Dis, 44, pp. 159-177; Lesprit, P., Brun-Buisson, C., Hospital antibiotic stewardship (2008) Curr Opin Infect Dis, 21, pp. 344-349; Davey, P., Brown, E., Fenelon, L., Interventions to improve antibiotic prescribing practices for hospital inpatients (2005) Cochrane Database Syst Rev, (4), pp. CD003543; MacDougall, C., Polk, R.E., Antimicrobial stewardship programs in health care systems (2005) Clin Microbiol Rev, 18, pp. 638-656; Ohl, C.A., Luther, V.P., Antimicrobial stewardship for inpatient facilities (2011) Hosp Med, 6 Suppl 1, pp. S4-S15; Aldeyab, M.A., Devine, M.J., Flanagan, P., Multihospital outbreak of Clostridium difficile ribotype 027 infection: epidemiology and analysis of control measures (2011) Infect Control Hosp Epidemiol, 32, pp. 210-219; Owens Jr., R.C., Donskey, C.J., Gaynes, R.P., Antimicrobial-associated risk factors for Clostridium difficile infection (2008) Clin Infect Dis, 46 Suppl 1, pp. S19-S31; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; Shardell, M., Harris, A.D., El-Kamary, S.S., Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies (2007) Clin Infect Dis, 45, pp. 901-907; Lopez-Lozano, J.M., Monnet, D.L., Yague, A., Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis (2000) Int J Antimicrob Agents, 14, pp. 21-31; Helfenstein, U., Box-Jenkins modelling in medical research (1996) Stat Methods Med Res, 5, pp. 3-22; Aldeyab, M.A., Monnet, D.L., López-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: a time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Lewis, S.J., Heaton, K.W., Stool form scale as a useful guide to intestinal transit time (1997) Scand J Gastroenterol, 32, pp. 920-924; Guidelines for ATC Classification and DDD Assignment, 2012 (2011), WHO Collaborating Centre for Drug Statistics Methodology. Oslo; Tobacman, J.K., Assessment of comorbidity: a review (1994) Clin Perform Qual Health Care, 2, pp. 23-32; Conlon, G., Aldeyab, M.A., McElnay, J.C., Improving and maintaining adherence with hospital antibiotic policies: a strategy for success (2011) J Hosp Infect, 77, pp. 88-89; Wagner, A.K., Soumerai, S.B., Zhang, F., Segmented regression analysis of interrupted time series studies in medication use research (2002) J Clin Pharm Ther, 27, pp. 299-309; Talpaert, M.J., Gopal Rao, G., Cooper, B.S., Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection (2011) J Antimicrob Chemother, 66, pp. 2168-2174; Valiquette, L., Cossette, B., Garant, M.P., Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain (2007) Clin Infect Dis, 45 Suppl 2, pp. S112-S121; Baxter, R., Ray, G.T., Fireman, B.H., Case-control study of antibiotic use and subsequent Clostridium difficile-associated diarrhea in hospitalized patients (2008) Infect Control Hosp Epidemiol, 29, pp. 44-50; Starr, J.M., Martin, H., McCoubrey, J., Risk factors for Clostridium difficile colonisation and toxin production (2003) Age Ageing, 32, pp. 657-660; Pépin, J., Saheb, N., Coulombe, M.A., Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec (2005) Clin Infect Dis, 41, pp. 1254-1260; McCusker, M.E., Harris, A.D., Perencevich, E., Fluoroquinolone use and Clostridium difficile-associated diarrhea (2003) Emerg Infect Dis, 9, pp. 730-733; Braegger, C.P., Nadal, D., Clarithromycin and pseudomembranous enterocolitis (1994) Lancet, 343, pp. 241-242; Guyot, A., Rawlins, M.D., Barrett, S.P., Clarithromycin appears to be linked with Clostridium difficile-associated diarrhoea in the elderly (2000) J Antimicrob Chemother, 46, pp. 642-643; McGowan Jr., J.E., Antimicrobial resistance in hospital organisms and its relation to antibiotic use (1983) Rev Infect Dis, 5, pp. 1033-1048; Aldeyab, M.A., Harbarth, S., Vernaz, N., The impact of antibiotic use on the incidence and resistance pattern of ESBL-producing bacteria in primary and secondary healthcare settings (2012) Br J Clin Pharmacol, 74, pp. 171-179; Monnet, D.L., MacKenzie, F.M., López-Lozano, J.M., Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000 (2004) Emerg Infect Dis, 10, pp. 1432-1441; Monnet, D.L., López-Lozano, J.M., Campillos, P., Making sense of antimicrobial use and resistance surveillance data: application of ARIMA and transfer function models (2001) Clin Microbiol Infect, 7 Suppl 5, pp. 29-36; Kaier, K., Hagist, C., Frank, U., Two time-series analyses of the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection (2009) Infect Control Hosp Epidemiol, 30, pp. 346-353; Gallini, A., Degris, E., Desplas, M., Influence of fluoroquinolone consumption in inpatients and outpatients on ciprofloxacin-resistant Escherichia coli in a university hospital (2010) J Antimicrob Chemother, 65, pp. 2650-2657; Vernaz, N., Huttner, B., Muscionico, D., Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community (2011) J Antimicrob Chemother, 66, pp. 928-935

PY - 2012/12/1

Y1 - 2012/12/1

N2 - 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.

AB - 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.

KW - C. difficile infection

KW - Quality improvement

KW - Risk classification

KW - Time-series analysis

KW - amoxicillin plus clavulanic acid

KW - cephalosporin derivative

KW - clindamycin

KW - macrolide

KW - quinolone derivative

KW - antiinfective agent

KW - antibiotic therapy

KW - article

KW - Clostridium difficile infection

KW - comorbidity

KW - drug utilization

KW - hospital policy

KW - human

KW - incidence

KW - major clinical study

KW - medication therapy management

KW - patient compliance

KW - retrospective study

KW - Clostridium difficile

KW - Clostridium infection

KW - cross infection

KW - diarrhea

KW - hospital

KW - isolation and purification

KW - microbiology

KW - standard

KW - statistics

KW - Anti-Bacterial Agents

KW - Clostridium Infections

KW - Cross Infection

KW - Diarrhea

KW - Drug Utilization

KW - Hospitals

KW - Humans

KW - Incidence

KW - Retrospective Studies

U2 - 10.1093/jac/dks330

DO - 10.1093/jac/dks330

M3 - Article

VL - 67

SP - 2988

EP - 2996

JO - Journal of Antimicrobial Chemotherapy

T2 - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 12

ER -