scholarly journals 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 ◽  
Vol 62 (3) ◽  
pp. 593-600 ◽  
Author(s):  
M. A. Aldeyab ◽  
D. L. Monnet ◽  
J. M. Lopez-Lozano ◽  
C. M. Hughes ◽  
M. G. Scott ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Time Series ◽  
Time Series Analysis ◽  
Infection Control ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Antibiotic Use ◽  
Methicillin Resistant ◽  
Series Analysis ◽  
Hospital Acquired ◽  
The Impact

scholarly journals Impact of Removal of Automatic 7-Day Stop Orders for Inpatient Antimicrobials

2020 ◽  
Vol 41 (S1) ◽  
pp. s264-s265
Author(s):  
Afia Adu-Gyamfi ◽  
Keith Hamilton ◽  
Leigh Cressman ◽  
Ebbing Lautenbach ◽  
Lauren Dutcher
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Treatment Interruptions ◽  
Days Of Therapy ◽  
Quasi Experimental ◽  
The Impact

Background: Automatic discontinuation of antimicrobial orders after a prespecified duration of therapy has been adopted as a strategy for reducing excess days of therapy (DOT) as part of antimicrobial stewardship efforts. Automatic stop orders have been shown to decrease antimicrobial DOT. However, inadvertent treatment interruptions may occur as a result, potentially contributing to adverse patient outcomes. To evaluate the effects of this practice, we examined the impact of the removal of an electronic 7-day ASO program on hospitalized patients. Methods: We performed a quasi-experimental study on inpatients in 3 acute-care academic hospitals. In the preintervention period (automatic stop orders present; January 1, 2016, to February 28, 2017), we had an electronic dashboard to identify and intervene on unintentionally missed doses. In the postintervention period (April 1, 2017, to March 31, 2018), the automatic stop orders were removed. We compared the primary outcome, DOT per 1,000 patient days (PD) per month, for patients in the automatic stop orders present and absent periods. The Wilcoxon rank-sum test was used to compare median monthly DOT/1,000 PD. Interrupted time series analysis (Prais-Winsten model) was used to compared trends in antibiotic DOT/1,000 PD and the immediate impact of the automatic stop order removal. Manual chart review on a subset of 300 patients, equally divided between the 2 periods, was performed to assess for unintentionally missed doses. Results: In the automatic stop order period, a monthly median of 644.5 antibiotic DOT/1,000 PD were administered, compared to 686.2 DOT/1,000 PD in the period without automatic stop orders (P < .001) (Fig. 1). Using interrupted time series analysis, there was a nonsignificant increase by 46.7 DOT/1,000 PD (95% CI, 40.8 to 134.3) in the month immediately following removal of automatic stop orders (P = .28) (Fig. 2). Even though the slope representing monthly change in DOT/1,000 PD increased in the period without automatic stop orders compared to the period with automatic stop orders, it was not statistically significant (P = .41). Manual chart abstraction revealed that in the period with automatic stop orders, 9 of 150 patients had 17 unintentionally missed days of therapy, whereas none (of 150 patients) in the period without automatic stop orders did. Conclusions: Following removal of the automatic stop orders, there was an overall increase in antibiotic use, although the change in monthly trend of antibiotic use was not significantly different. Even with a dashboard to identify missed doses, there was still a risk of unintentionally missed doses in the period with automatic stop orders. Therefore, this risk should be weighed against the modest difference in antibiotic utilization garnered from automatic stop orders.Funding: NoneDisclosures: None

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.

The impact of methicillin-resistant Staphylococcus aureus on ENT practice

2006 ◽  
Vol 120 (9) ◽  
pp. 713-717 ◽  
Author(s):  
I J Nixon ◽  
B J G Bingham
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Control ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Methicillin Resistance ◽  
Resistant Bacteria ◽  
Antibiotic Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Methicillin Resistant ◽  
The Impact

Antibiotic-resistant bacteria are increasingly common and present a major problem for the modern day ENT surgeon. This article reviews the development of methicillin resistance in Staphylococcus aureus and how it has come to affect ENT practice. We look at the evidence behind measures taken to help deal with methicillin-resistant Staphylococcus aureus (MRSA) and to prevent its spread. We go on to suggest a departmental guideline for infection control, which we hope can be implemented to help deal with the problems created by MRSA.

scholarly journals Prevalence and Risk Factors for Methicillin-Resistant Staphylococcus aureus Carriage among Healthcare Workers in a Tertiary Health Facility in Nigeria

2021 ◽  
pp. 43-52
Author(s):  
Oluwalana T. Oyekale ◽  
Bola O. Ojo ◽  
Damilola E. Oguntunmbi ◽  
Oluwatoyin I. Oyekale
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Critical Care ◽  
Infection Control ◽  
Healthcare Workers ◽  
Skin Infection ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Antibiotic Use ◽  
Isolation Rate ◽  
Methicillin Resistant

Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonized healthcare workers (HCWs) constitute massive threat to the well-being of hospitalized patients due to their ability to transmit this multidrug-resistant (MDR) bacteria strain in hospital settings. Aim: To determine the prevalence of MRSA carriage/colonization among HCWs, to identify risk-factors associated with colonization/carriage, and to determine the antibiotic resistance pattern of isolates. Study Design: A cross-sectional study. Materials and Methods: A total of 333 randomly selected consenting HCWs from most hospital care units were studied. Data on demographic characteristics and infection control practices were obtained from participants with the aid of questionnaire. Swabs of the anterior nares and hands of participants were cultured on oxacillin-containing mannitol salt agar (MSA), S. aureus was identified using convectional criteria and MRSA was identified by cefoxitin disc diffusion technique. Antibiotic susceptibility testing was carried out on all isolated MRSA. Results: The carriage rate of MRSA was high (21.3%). Isolation was significantly higher among; males compared to females (P=.035), staff of critical care units compared to other care units (P=.049), among doctors and nurses compared to other HCWs (P=.0031). Poor handwashing practices (P<.001), presence of wound or skin infection (P<.001) and recent antibiotic use (P=.006) were associated with higher isolation rate. Isolation rate was higher from the nose (15.0%) than from the hands (6.3%). Isolates demonstrated low resistance to clindamycin (16.9%) and ciprofloxacin (16.9%). No isolate was resistant to vancomycin. Conclusion: In this study; colonization of HCWs by MRSA was high, a male doctor or nurse from critical care unit, with poor handwashing practices, wound or skin infection, and recent antibiotic use had a higher risk of MRSA carriage/colonization. No MRSA isolated was resistant to vancomycin. Improved infection control policies and practices are needed to curtail this trend in hospital settings.

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