Modelling the impact of antibiotic use and infection control agents on the incidence of methicillin-resistant Staphylococcus aureus incidence rates in hospital, informed by identifying antibiotic usage thresholds utilising non-linear time series analysis

Kathryn Burnett, Sara Gardner, P. A. McCarron, Geraldine Conlon-Bingham, David Farren, Michael Scott

Research output: Contribution to conferenceAbstract

Abstract

Background: Evidence has shown the relationship between antibiotic use and antimicrobial resistance to be linear; the more antibiotics consumed the higher the resistance levels seen, irrespective of the intensity of antimicrobial use. However mathematical models have suggested that the relationship between antibiotic use, infection control agents and antimicrobial resistance is non-linear and that there is a threshold level of drug, above which the persistent selection of the antibiotic in the environment will lead to the development and spread of antimicrobial resistance. These thresholds may define safe usage levels for
antibiotic stewardship activities, avoiding over restriction and bringing restricted antibiotics back into practice.
Materials/methods: We applied a NLTSA method to identify thresholds in population antibiotic use and infection control agent use that influence MRSA incidence rates within a secondary care hospital in Northern Ireland in order to inform an antibiotic stewardship policy (ASP).
Results: The NLTSA model identified critical thresholds for hospital consumption of fluoroquinolones, co-amoxiclav and alcohol-based hand rub (ABHR). The thresholds identified for fluoroquinolones and co-amoxiclav were 6.13 Defined Daily Doses (DDDs)/100 Occupied Bed Days (OBDs) and 37.17 DDDs/100 OBDs respectively; the consumption of both was identified to be above the thresholds. An inverse relationship was observed with increases in hospital consumption of ABHR up to 0.81 Litres/100 OBDs, above which further increases were not associated with further declines in MRSA. The identified thresholds were then translated into ASP suggestions, based on consumption in the previous 12 months. Fluoroquinolone and co-amoxiclav consumption should be reduced by 30% and 10% respectively in order to reduce consumption below the identified thresholds, ABHR levels need to be maintained.
Conclusions: NLTSA can provide quantitative goals for antibiotic stewardship interventions by identifying critical thresholds in antimicrobial consumption. An ASP has been devised that restricts fluoroquinolone and co-amoxiclav consumption to a level below threshold to determine if the reduction in consumption has an effect on MRSA incidence within the hospital.
Original languageEnglish
Pages1107
Number of pages1
Publication statusPublished - 5 May 2020
Event30th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) - France (cancelled COVID-19), Paris, France
Duration: 18 Apr 202021 Apr 2020
Conference number: 30

Conference

Conference30th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID)
Abbreviated titleECCMID 2020
CountryFrance
CityParis
Period18/04/2021/04/20

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