Eradication of Staphylococcus aureus post-sternotomy mediastinitis following the implementation of universal pre-operative nasal decontamination with mupirocin: an interrupted time-series analysis

2021 ◽  
Author(s):  
Rafael San-Juan ◽  
Consuelo Alejandra Gotor-Pérez ◽  
Francisco López-Medrano ◽  
Mario Fernández-Ruiz ◽  
David Lora ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Series Analysis

Abstract Background Although pre-surgical nasal decontamination with mupirocin (NDM) has been advocated as a measure for preventing post-surgical mediastinitis (PSM) due to Staphylococcus aureus, this strategy is not universally recommended due to the lack of robust supporting evidence. We aimed to evaluate the role of pre-operative NDM in the annual incidence of S. aureus PSM at our institution. Methods An interrupted time-series analysis, with autoregressive error model, was applied to our single-center cohort by comparing pre-intervention (1990-2003) and post-intervention period (2005 to 2018). Logistic regression was performed to analyze risk factors for S. aureus PSM. Findings 12,236 sternotomy procedures were analyzed (6,370 [52.1%] and 5,866 [47.9%] in the pre-intervention and post-intervention periods, respectively). The mean annual percentage adherence to NDM estimated over the post-interventional period was 90.2%. Only four out of 127 total cases of S. aureus PSM occurred during the 14-years post-intervention period (0.68/1,000 sternotomies vs. 19.31/1,000 in pre-interventional period [p<0.0001]). Interrupted time-series analysis demonstrated a statistically significant annual reduction of S. aureus PSM trend of –9.85 cases per 1,000 sternotomies (-13.17 to -6.5, P-value< 0·0001) in 2005, with a decreasing trend maintained over the following five years with an estimated relative reduction of 84.8% (95% CI: 89·25 to 74·09). Chronic obstructive pulmonary disease was the single independent risk factor for S. aureus PSM (odds ratio: 3.7; 95% CI: 1.72-7.93) and was equally distributed in patients undergoing sternotomy during pre or post-intervention periods. Interpretation Our experience suggests that the implementation of pre-operative NDM reduces significantly the incidence of S. aureus PSM.

scholarly journals England's Lockdown vs. Sweden's Herd Immunity: A Comparison of the Daily New COVID-19 Cases and Related Deaths Using Comparative Interrupted Time Series Analysis

2020 ◽  
Author(s):  
Moaath Mustafa Ali ◽  
Yazan Samhouri ◽  
Marwa Sabha ◽  
Lynna Alnimer
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Herd Immunity ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Series Analysis ◽  
Before And After ◽  
Rebound Increase ◽  
Related Mortality

Background: There is a lack of empirical evidence that lockdowns decrease daily cases of COVID-19 and related mortality compared to herd immunity. England implemented a delayed lockdown on March 23, 2020, but Sweden did not. We aim to examine the effect of lockdown on daily COVID-19 cases and related deaths during the first 100 days post-lockdown. Methods: We compared daily cases of COVID-19 infection and related mortality in England and Sweden before and after lockdown intervention using a comparative-interrupted time series analysis. The period included was from COVID-19 pandemic onset till June 30, 2020. Results: The adjusted-rate of daily COVID-19 infections was eight cases/10,000,000 person higher in England than Sweden before lockdown order (95% CI: 2-14, P=0.01). On the day of intervention (lagged lockdown), England had 693 more COVID-19 cases/10,000,000 person compared to Sweden (95% CI: 467-920, P<0.001). Compared to the pre-intervention period, the adjusted daily confirmed cases rate decreased by 19 cases/ 10,000,000 person compared to Sweden (95% CI: 13-26, P<0.001). There was a rate excess of 1.5 daily deaths/ 10,000,000 person in England compared to Sweden pre-intervention (95% CI: 1-2, P<0.001). The increased mortality rate resulted in 50 excess deaths/ 10,000,000 person related to COVID-19 in England compared to Sweden on the day of lockdown (95% CI: 30-71, P<0.001). Post-intervention, the rate of daily deaths in England decreased by two deaths/ 10,000,000 person compared to Sweden (95% CI: 1-3, P<0.001). During phases one and two of lockdown lifting in England, there was no rebound increase in daily cases or deaths compared to Sweden. Conclusion: The lockdown order implemented in England on March 23, 2020, effectively decreased the daily new cases rate and related mortality compared to Sweden. There was no short-term increase in COVID-19 cases and related-deaths after the phases one and two of the lifting of restrictions in England compared to Sweden. This study provides empirical, comparative evidence that lockdowns slow the spread of COVID-19 in communities compared to herd immunity.

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 Effect of the Colombian Emergency Department Triage Policy on the timeliness of ED care and the mortality in patients with cerebrovascular attack: A controlled interrupted time series analysis

2020 ◽  
Author(s):  
Carlos Eduardo Vallejo ◽  
Daniel Felipe Patiño-Lugo ◽  
Daniel Camilo Aguirre-Acevedo ◽  
Juan Pablo Acosta
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Reperfusion Therapy ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Emergency Department Triage ◽  
The City

Abstract Background: Ischemic Cerebrovascular Accident (CVA) is the second cause of death and one of the leading causes of disability in the world. In Colombia, there is a prevalence of 0.16% and a mortality rate of 16.82 deaths per 100,000 inhabitants. This study assessed the Colombian Ministry of Health’s Emergency Department Triage Policy (TP) on the timeliness of hospital care, the mortality, and change in reperfusion therapy of patients with the first episode of an CVA in the Emergency Department (ED) of a hospital in the city of Medellín.Methods: A controlled interrupted time series analysis between January 2011 and November 2017 was performed in one emergency department using segmented regression analysis. The emergency department of other hospital was used as a control. Data were aggregated by month for both ED, including 60 pre-intervention and 23 intervention points.Results: No decrease in the timeliness of care in the ED was found in patients with a stroke after implementing the Colombian Ministry of Health’s TP (12.55 minutes, IC -17.07, 42.17; p: 0.4). The TP intervention produced a level change in the timeliness of care in Triage I and II subgroups, of 28.34 minutes (IC 95% 16.9, 39.79; p valor 0.00), there was no change in the trend. The classification of Triage I and II was more frequent in the post-intervention period. There was evidence of the increase in reperfusion therapy with tissue plasminogen activator (rTPA) in 4% (95% CI – 0.08, - 0.01; p value 0.01). Mortality increased 4% in the post-intervention period without being statistically significant (0.04, IC 95% - 0.08 – 0; p valor 0.06). There were no significant changes in the same outcomes in the control group.Conclusions: The implementation of the triage policy allowed improving the timeliness of ED care only in patients with ischemic CVA classified as Triage I and II, in an Emergency Department in the city of Medellín, Colombia.

scholarly journals Fall of Community-Acquired Pneumonia in Children Following COVID-19 Non-Pharmaceutical Interventions: A Time Series Analysis

Pathogens ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1375
Author(s):  
Alexis Rybak ◽  
David Dawei Yang ◽  
Cécile Schrimpf ◽  
Romain Guedj ◽  
Corinne Levy ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Pediatric Emergency ◽  
Community Acquired Pneumonia ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Series Analysis ◽  
The Impact ◽  
Pharmaceutical Interventions

Non-pharmaceutical interventions (NPIs) were implemented to reduce the spread of coronavirus disease 2019 (COVID-19). A first national lockdown was decided in France on the 17 March 2020. These measures had an impact on other viral and non-viral infectious diseases. We aimed to assess this impact on community-acquired pneumonia (CAP) in children. We performed a quasi-experimental interrupted time series analysis. We used data from a French prospective surveillance system of six pediatric emergency departments (PEDs). All visits from 1 January 2017 to 31 December 2020 were included. Pre-intervention period was before 17 March 2020 and post-intervention period was after 18 March 2020. We estimated the impact on the weekly number of visits for CAP and CAP admission using quasi-Poisson regression modeling. A total of 981,782 PEDs visits were analyzed; among them, 8318 visits were associated with CAP, and 1774 of these were followed by a hospital admission. A major decrease was observed for CAP visits (–79.7% 95% CI [–84.3; –73.8]; p < 0.0001), and CAP admission (–71.3% 95 CI [–78.8; –61.1]; p < 0.0001). We observed a dramatic decrease of CAP in children following NPIs implementation. Further studies are required to assess the long-term impact of these measures.

scholarly journals Assessing the impact of SIGN 136 on opioid prescribing rates in Scotland: An interrupted time series analysis

2021 ◽  
Author(s):  
Harry L. Hébert ◽  
Daniel R. Morales ◽  
Nicola Torrance ◽  
Blair H. Smith ◽  
Lesley A. Colvin
Keyword(s):  
Chronic Pain ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
The Impact

AbstractBackgroundOpioids are used to treat patients with chronic pain, but their long-term use is associated with harms. In December 2013, SIGN 136 was published, providing a comprehensive evidence-based guideline for the assessment and management of chronic pain in ScotlandAimsThis study aimed to examine the impact of SIGN 136 on opioid prescribing trends and costs across the whole of Scotland.MethodsOpioid prescribing data and average cost per item were obtained from Public Health Scotland. An interrupted time series analysis examined the effects of SIGN 136 publication on the number of items prescribed per 1,000 population per quarter for 29 opioids (or opioid-containing combinations) from 2005 to 2019 inclusive. Exploratory analysis was conducted in NHS Tayside and NHS Fife combined and then up-scaled to all 14 NHS Scotland health boards. A similar approach was also used to assess the effect of SIGN 136 on estimated gross ingredient costs per quarter.ResultsAt six years post-intervention there was a relative reduction in opioid prescribing of 18.8% (95% CI: 16.0-21.7) across Scotland. There was also a relative reduction of 22.8% (95%: 14.9-30.1) in gross ingredient cost nationally. Opioid prescribing increased significantly pre-intervention across all 14 NHS Scotland health boards (2.19 items per 1000 population per quarter), followed by a non-significant change in level and a significant negative change in trend post-intervention (−2.69 items per 1000 population per quarter). Similar findings were observed locally in NHS Tayside and NHS Fife.ConclusionsThe publication of SIGN 136 coincided with a statistically significant reduction in opioid prescribing rates in Scotland and suggests that changes in clinical policy are having a positive effect on prescribing practices in primary care. These prescribing trends appear to be in contrast to the UK as a whole.

scholarly journals Did the ban on serving raw beef liver in restaurants decrease Enterohemorrhagic Escherichia coli infection in Japan?: an interrupted time-series analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kentaro Iwata ◽  
Michihiko Goto
Keyword(s):  
Escherichia Coli ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Incidence Rates ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Beef Liver ◽  
Series Analysis ◽  
The Impact

Abstract Background Enterohemorrhagic Escherichia coli (EHEC) is an important pathogen that causes diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS). After an EHEC outbreak involving uncooked beef, serving raw beef liver dishes at restaurants was completely banned starting on July 1, 2012 in Japan. However, its long-term associations with the incidence rates of EHEC infections have never been assessed by formal interrupted time-series analysis (ITSA). Methods A retrospective cohort study to assess the impact of banning raw beef liver provision at restaurants was conducted. The weekly incidence of asymptomatic and symptomatic EHEC infections, the incidence of HUS, and deaths were extracted from the national reportable diseases database from January 2008 to December 2017. ITSA was conducted to evaluate the impact of banning raw beef liver from July 2012. To account for a potential simultaneous external effect, the additional regulation on raw beef red meat handling (implemented in May 2011) and the seasonality were also incorporated into the model. Results There were 32,179 asymptomatic and 21,250 symptomatic EHEC infections (including 717 HUS cases and 26 deaths) reported during the study period. During the pre-intervention period (before week 27, 2012), there were 0.45 asymptomatic EHEC infections per million-persons per week. The mean post-intervention asymptomatic EHEC infections were 0.51 per million-persons per week. ITSA revealed no baseline trend or change in the intercept and trend (0.002 infections per million-persons per week, 95% Confidence interval − 0.03-0.04, p = 0.93, 1.22, CI -1.96-4.39, p = 0.45, and − 0.006, CI -0.003-0.02, p = 0.68, respectively). For symptomatic EHEC infections, there were 0.30 cases per million per week during the pre-intervention period, and it became 0.33 cases per million per week after the intervention. Time series modeling again did not show a significant baseline trend or changes in the intercept and trend (0.0005, CI -0.02-0.02, p = 0.96, 0.69, CI -1.75-3.12, p = 0.58, and − 0.003, CI -0.02-0.01, p = 0.76, respectively). Conclusion We did not find a statistically significant reduction in the overall incidence rates of both asymptomatic and symptomatic EHEC infections in Japan after implementing measures, including a ban on serving raw beef liver dishes in the restaurant industry.

scholarly journals The impact of COVID-19 on outpatient antibiotic prescriptions in Ontario, Canada; An interrupted time series analysis

2021 ◽  
Author(s):  
Taito Kitano ◽  
Kevin A Brown ◽  
Nick Daneman ◽  
Derek R MacFadden ◽  
Bradley J Langford ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Respiratory Infections ◽  
Population Level ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
The Impact

Abstract Background The COVID-19 pandemic has potentially impacted outpatient antibiotic prescribing. Investigating this impact may identify stewardship opportunities in the ongoing COVID-19 period and beyond. Methods We conducted an interrupted time series analysis on outpatient antibiotic prescriptions and antibiotic prescriptions/patient visits in Ontario, Canada between January 2017 and December 2020 to evaluate the impact of the COVID-19 pandemic on population-level antibiotic prescribing by prescriber’s specialty, patient demographics and conditions. Results In the evaluated COVID-19 period (March-December 2020), there was a 31.2% [95% CI: 27.0%–35.1%] relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% [32.5%–41.3%] among family physicians, 30.7% [25.8%–35.2%] among sub-specialist physicians, 12.1% [4.4%–19.2%] among dentists and 25.7% [21.4%–29.8%] among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% [38.4–48.6%]. Total patient visits and visits for respiratory infections decreased by 10.7% [5.4%–15.6%] and 49.9% [43.1%%–55.9%]). Total antibiotic prescriptions/1,000 visits decreased by 27.5% [21.5%–33.0%], while antibiotics indicated for respiratory infections/1,000 visits with respiratory infections only decreased by 6.8% [2.7%–10.8%]. Conclusion The reduction in outpatient antibiotic prescribing during the COVID-19 pandemic was driven by less antibiotic prescribing for respiratory indications and largely explained by decreased visits for respiratory infections.

scholarly journals Has the Emergence of Community-Associated Methicillin-Resistant Staphylococcus aureus Increased Trimethoprim-Sulfamethoxazole Use and Resistance?: a 10-Year Time Series Analysis

2012 ◽  
Vol 56 (11) ◽  
pp. 5655-5660 ◽  
Author(s):  
Jameson B. Wood ◽  
Donald B. Smith ◽  
Errol H. Baker ◽  
Stephen M. Brecher ◽  
Kalpana Gupta
Keyword(s):  
Staphylococcus Aureus ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Rate Of Change ◽  
Interrupted Time Series Analysis ◽  
Methicillin Resistant ◽  
Content Type ◽  
Series Analysis ◽  
The Relationship

ABSTRACTThere are an increasing number of indications for trimethoprim-sulfamethoxazole use, including skin and soft tissue infections due to community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA). Assessing the relationship between rates of use and antibiotic resistance is important for maintaining the expected efficacy of this drug for guideline-recommended conditions. Using interrupted time series analysis, we aimed to determine whether the 2005 emergence of CA-MRSA and recommendations of trimethoprim-sulfamethoxazole as the preferred therapy were associated with changes in trimethoprim-sulfamethoxazole use and susceptibility rates. The data from all VA Boston Health Care System facilities, including 118,863 inpatient admissions, 6,272,661 outpatient clinic visits, and 10,138 isolates were collected over a 10-year period. There was a significant (P= 0.02) increase in trimethoprim-sulfamethoxazole prescriptions in the post-CA-MRSA period (1,605/year) compared to the pre-CA-MRSA period (1,538/year). Although the overall susceptibility ofEscherichia coliandProteusspp. to trimethoprim-sulfamethoxazole decreased over the study period, the rate of change in the pre- versus the post-CA-MRSA period was not significantly different. The changes in susceptibility rates ofS. aureusto trimethoprim-sulfamethoxazole and to methicillin were also not significantly different. The CA-MRSA period is associated with a significant increase in use of trimethoprim-sulfamethoxazole but not with significant changes in the rates of susceptibilities among clinical isolates. There is also no evidence for selection of organisms with increased resistance to other antimicrobials in relation to increased trimethoprim-sulfamethoxazole use.

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