Approaching zero : temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus
Dancer, S.J. and Kirkpatrick, P. and Corcoran, D.S. and Christison, F. and Farmer, D. and Robertson, Chris (2013) Approaching zero : temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus. International Journal of Antimicrobial Agents, 41 (2). 137–142. ISSN 0924-8579
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Abstract
A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum -lactamase (ESBL)- producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P < 0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P = 0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens.
Creators(s): | Dancer, S.J., Kirkpatrick, P., Corcoran, D.S., Christison, F., Farmer, D. and Robertson, Chris; | Item type: | Article |
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ID code: | 42473 |
Keywords: | antimicrobial stewardship, clostridturn difficule, MRSA, ESBL-producing coliforms, hospital acquired infection, temporal effects, antibiotic policy , restrictive , clostridium difficile, staphylococcus aureus, Mathematics, Medicine, Infectious Diseases, Microbiology (medical), Pharmacology (medical) |
Subjects: | Science > Mathematics Medicine |
Department: | Faculty of Science > Mathematics and Statistics |
Depositing user: | Pure Administrator |
Date deposited: | 07 Jan 2013 15:52 |
Last modified: | 09 Feb 2021 03:29 |
Related URLs: | |
URI: | https://strathprints.strath.ac.uk/id/eprint/42473 |
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