Decreased Resistance of Pseudomonas aeruginosa with Restriction of Ciprofloxacin in a Large Teaching Hospital's Intensive Care and Intermediate Care Units

2012 ◽  
Vol 33 (4) ◽  
pp. 368-373 ◽  
Author(s):  
G. Jonathan Lewis ◽  
Xiangming Fang ◽  
Michael Gooch ◽  
Paul P. Cook
Keyword(s):  
Time Series ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Tertiary Care ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Intermediate Care ◽  
Interrupted Time Series Analysis ◽  
Gram Negative

Objective.To examine the effect of restricting ciprofloxacin on the resistance of nosocomial gram-negative bacilli, including Pseudomonas aeruginosa, to antipseudomonal carbapenems.Design.Interrupted time-series analysis.Setting.Tertiary care teaching hospital with 11 intensive care and intermediate care units with a total of 295 beds.Patients.All nosocomial isolates of P. aeruginosa.Intervention.Restriction of ciprofloxacin.Results.There was a significant decreasing trend observed in the percentage (P = .0351) and the rate (P = .0006) of isolates of P. aeruginosa that were resistant to antipseudomonal carbapenems following the restriction of ciprofloxacin. There was also a significant decreasing trend observed in the percentage (P = .0017) and the rate (P = .0001) of isolates of ciprofloxacin-resistant P. aeruginosa. The rate of cefepime-resistant P. aeruginosa isolates declined (P = .004 ) but the percentage of cefepime-resistant P. aeruginosa isolates did not change. There were no significant changes observed in the rate or the percentage of piperacillin-tazobactam-resistant P. aeruginosa isolates. There were no significant changes observed in the susceptibilities of nosocomial Enterobacteriaciae or Acinetobacter baumannii isolates that were resistant to carbapenems. Over the study period there was a significant increase in the use of carbapenems (P = .0134); the use of ciprofloxacin decreased significantly (P = .0027). There were no significant changes in the use of piperacillin-tazobactam or cefepime.Conclusion.Restriction of ciprofloxacin was associated with a decreased resistance of P. aeruginosa isolates to antipseudomonal carbapenems and ciprofloxacin in our hospital's intermediate care and intensive care units. There were no changes observed in the susceptibilities of nosocomial Enterobacteriaciae or A. baumannii to carbapenems, despite increased carbapenem use. Reducing ciprofloxacin use may be a means of controlling multidrug-resistant P. aeruginosa.

scholarly journals Using Interrupted Time Series Analysis To Assess Associations of Fluoroquinolone Formulary Changes with Susceptibility of Gram-Negative Pathogens and Isolation Rates of Methicillin-Resistant Staphylococcus aureus

2006 ◽  
Vol 50 (6) ◽  
pp. 2106-2112 ◽  
Author(s):  
John A. Bosso ◽  
Patrick D. Mauldin
Keyword(s):  
Staphylococcus Aureus ◽  
Time Series ◽  
Time Series Analysis ◽  
Bacterial Resistance ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Isolation Rate ◽  
Gram Negative ◽  
Methicillin Resistant ◽  
Series Analysis

ABSTRACT The use of fluoroquinolones has been linked to increasing bacterial resistance and infection and/or colonization with already resistant pathogens both as a risk factor and based on volume of use. Changes in individual fluoroquinolones used in an institution may also be related to these clinical problems. Interrupted time series analysis, which allows for assessment of the associations of an outcome attributable to a specific event in time, was used to study the effect of changes in our hospital's fluoroquinolone formulary on fluoroquinolone susceptibility rates in select gram-negative pathogens and the methicillin-resistant Staphylococcus aureus (MRSA) isolation rate. Susceptibility rates to ciprofloxacin were considered for the period of 1993 through 2004, while the MRSA isolation rate was assessed from 1995 through 2004. Levofloxacin was added to the formulary in 1999, and gatifloxacin was substituted for levofloxacin in 2001. Statistically significant changes in the already declining rates of susceptibility of Pseudomonas aeruginosa (P, 0.042) and Escherichia coli (P, 0.004) to ciprofloxacin and in the already rising MRSA isolation rate (P, 0.001) were associated with the addition of levofloxacin to the formulary. Substitution of gatifloxacin for levofloxacin on the formulary was associated with reversals in the downward trend in E. coli susceptibility to ciprofloxacin and the upward trend in MRSA isolation rate. No associations were detected on susceptibility of Klebsiella pneumoniae or Proteus mirabilis to ciprofloxacin. These findings suggest that potential changes in susceptibility to fluoroquinolones and isolation of MRSA may vary by both drug and organism.

scholarly journals Outcomes of a Care Coordination Guardianship Intervention for Adults with Severe Mental Illness: An Interrupted Time Series Analysis

2019 ◽  
Vol 47 (3) ◽  
pp. 468-474
Author(s):  
Eliot Levine ◽  
Catherine Jett ◽  
Jeremiah Johnson ◽  
Heather Connors
Keyword(s):  
Time Series ◽  
Mental Illness ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Severe Mental Illness ◽  
Care Coordination ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Legal Outcomes

AbstractThis study investigates the impacts of an intensive care coordination intervention for adults with severe mental illness who have guardians. Program impacts on medical and legal outcomes were assessed using interrupted time series analysis. Program participation was associated with statistically significant reductions in the level and trend of psychiatric hospitalizations, number of days in psychiatric hospitals, emergency room visits, and arrests. Days incarcerated did not change significantly. The decrease in medical and legal outcomes may be associated with decreased spending on these services. The program and other intensive care coordination interventions for this population warrant further replication and research.

Impact of a Carbapenem Stewardship Programme on the Incidence of Carbapenem-Resistant Gram-Negative Bacilli: An Interrupted Time-Series Analysis

2020 ◽  
Author(s):  
Teresa López-Viñau López ◽  
Germán Peñalva ◽  
Lucrecia García-Martinez ◽  
Juan José Castón ◽  
Montserrat Muñoz-Rosa ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Gram Negative ◽  
Series Analysis ◽  
Carbapenem Resistant
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