An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings

Mamoon A. Aldeyab, Mary P. Kearney, Michael G. Scott, Motasem A. Aldiab, Yaser M. Alahmadi, Feras W. Darwish Elhajji, Fidelma A. Magee, James C. McElnay

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Objectives: To evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital Clostridium difficile infection (CDI) incidence rates. A secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool. Methods: This was an interventional, retrospective, ecological investigation in a medium-sized hospital over 6.5 years (January 2004 to June 2010). The intervention was the restriction of high-risk antibiotics (second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and clindamycin). Amoxicillin/clavulanic acid and macrolides were classified as medium-risk antibiotics based on time-series analysis findings and their use was monitored. The intervention was evaluated by segmented regression analysis of interrupted time series. Results: The intervention was associated with a significant change in level of use of high-risk antibiotics (coefficient -17.3, P< 0.0001) and with a borderline significant trend change in their use being reduced by 0.156 defined daily doses/100 bed-days per month (P=0.0597). The reduction in the use of high-risk antibiotics was associated with a significant change in the incidence trend of CDI (P=0.0081), i.e. the CDI incidence rate decreased by 0.0047/100 bed-days per month. Analysis showed that variations in the incidence of CDI were affected by the age-adjusted comorbidity index with a lag of 1 month (coefficient 0.137051, P=0.0182). Significant decreases in slope (coefficient -0.414, P=.0309) post-intervention were also observed for the monitored medium-risk antibiotics. Conclusions: The restriction of the high-risk antibiotics contributed to both a reduction in their use and a reduction in the incidence of CDI in the study site hospital. Time-series analysis can be utilized as a risk classification tool with utility in antibiotic stewardship design and quality improvement programmes.

Original languageEnglish
Article numberdks330
Pages (from-to)2988-2996
Number of pages9
JournalJournal of Antimicrobial Chemotherapy
Volume67
Issue number12
Early online date16 Aug 2012
DOIs
Publication statusPublished - Dec 2012
Externally publishedYes

Fingerprint

Clostridium Infections
Clostridium difficile
Anti-Bacterial Agents
Incidence
Cephalosporins
Amoxicillin-Potassium Clavulanate Combination
Clindamycin
Fluoroquinolones
Macrolides
Quality Improvement
Comorbidity
Regression Analysis

Cite this

Aldeyab, Mamoon A. ; Kearney, Mary P. ; Scott, Michael G. ; Aldiab, Motasem A. ; Alahmadi, Yaser M. ; Darwish Elhajji, Feras W. ; Magee, Fidelma A. ; McElnay, James C. / An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. In: Journal of Antimicrobial Chemotherapy. 2012 ; Vol. 67, No. 12. pp. 2988-2996.
@article{c504e1b924664abbad219fe82ed38bfd,
title = "An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings",
abstract = "Objectives: To evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital Clostridium difficile infection (CDI) incidence rates. A secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool. Methods: This was an interventional, retrospective, ecological investigation in a medium-sized hospital over 6.5 years (January 2004 to June 2010). The intervention was the restriction of high-risk antibiotics (second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and clindamycin). Amoxicillin/clavulanic acid and macrolides were classified as medium-risk antibiotics based on time-series analysis findings and their use was monitored. The intervention was evaluated by segmented regression analysis of interrupted time series. Results: The intervention was associated with a significant change in level of use of high-risk antibiotics (coefficient -17.3, P< 0.0001) and with a borderline significant trend change in their use being reduced by 0.156 defined daily doses/100 bed-days per month (P=0.0597). The reduction in the use of high-risk antibiotics was associated with a significant change in the incidence trend of CDI (P=0.0081), i.e. the CDI incidence rate decreased by 0.0047/100 bed-days per month. Analysis showed that variations in the incidence of CDI were affected by the age-adjusted comorbidity index with a lag of 1 month (coefficient 0.137051, P=0.0182). Significant decreases in slope (coefficient -0.414, P=.0309) post-intervention were also observed for the monitored medium-risk antibiotics. Conclusions: The restriction of the high-risk antibiotics contributed to both a reduction in their use and a reduction in the incidence of CDI in the study site hospital. Time-series analysis can be utilized as a risk classification tool with utility in antibiotic stewardship design and quality improvement programmes.",
keywords = "C. difficile infection, Quality improvement, Risk classification, Time-series analysis",
author = "Aldeyab, {Mamoon A.} and Kearney, {Mary P.} and Scott, {Michael G.} and Aldiab, {Motasem A.} and Alahmadi, {Yaser M.} and {Darwish Elhajji}, {Feras W.} and Magee, {Fidelma A.} and McElnay, {James C.}",
year = "2012",
month = "12",
doi = "10.1093/jac/dks330",
language = "English",
volume = "67",
pages = "2988--2996",
journal = "Journal of Antimicrobial Chemotherapy",
issn = "0305-7453",
publisher = "Oxford University Press",
number = "12",

}

An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. / Aldeyab, Mamoon A.; Kearney, Mary P.; Scott, Michael G.; Aldiab, Motasem A.; Alahmadi, Yaser M.; Darwish Elhajji, Feras W.; Magee, Fidelma A.; McElnay, James C.

In: Journal of Antimicrobial Chemotherapy, Vol. 67, No. 12, dks330, 12.2012, p. 2988-2996.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings

AU - Aldeyab, Mamoon A.

AU - Kearney, Mary P.

AU - Scott, Michael G.

AU - Aldiab, Motasem A.

AU - Alahmadi, Yaser M.

AU - Darwish Elhajji, Feras W.

AU - Magee, Fidelma A.

AU - McElnay, James C.

PY - 2012/12

Y1 - 2012/12

N2 - Objectives: To evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital Clostridium difficile infection (CDI) incidence rates. A secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool. Methods: This was an interventional, retrospective, ecological investigation in a medium-sized hospital over 6.5 years (January 2004 to June 2010). The intervention was the restriction of high-risk antibiotics (second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and clindamycin). Amoxicillin/clavulanic acid and macrolides were classified as medium-risk antibiotics based on time-series analysis findings and their use was monitored. The intervention was evaluated by segmented regression analysis of interrupted time series. Results: The intervention was associated with a significant change in level of use of high-risk antibiotics (coefficient -17.3, P< 0.0001) and with a borderline significant trend change in their use being reduced by 0.156 defined daily doses/100 bed-days per month (P=0.0597). The reduction in the use of high-risk antibiotics was associated with a significant change in the incidence trend of CDI (P=0.0081), i.e. the CDI incidence rate decreased by 0.0047/100 bed-days per month. Analysis showed that variations in the incidence of CDI were affected by the age-adjusted comorbidity index with a lag of 1 month (coefficient 0.137051, P=0.0182). Significant decreases in slope (coefficient -0.414, P=.0309) post-intervention were also observed for the monitored medium-risk antibiotics. Conclusions: The restriction of the high-risk antibiotics contributed to both a reduction in their use and a reduction in the incidence of CDI in the study site hospital. Time-series analysis can be utilized as a risk classification tool with utility in antibiotic stewardship design and quality improvement programmes.

AB - Objectives: To evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital Clostridium difficile infection (CDI) incidence rates. A secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool. Methods: This was an interventional, retrospective, ecological investigation in a medium-sized hospital over 6.5 years (January 2004 to June 2010). The intervention was the restriction of high-risk antibiotics (second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and clindamycin). Amoxicillin/clavulanic acid and macrolides were classified as medium-risk antibiotics based on time-series analysis findings and their use was monitored. The intervention was evaluated by segmented regression analysis of interrupted time series. Results: The intervention was associated with a significant change in level of use of high-risk antibiotics (coefficient -17.3, P< 0.0001) and with a borderline significant trend change in their use being reduced by 0.156 defined daily doses/100 bed-days per month (P=0.0597). The reduction in the use of high-risk antibiotics was associated with a significant change in the incidence trend of CDI (P=0.0081), i.e. the CDI incidence rate decreased by 0.0047/100 bed-days per month. Analysis showed that variations in the incidence of CDI were affected by the age-adjusted comorbidity index with a lag of 1 month (coefficient 0.137051, P=0.0182). Significant decreases in slope (coefficient -0.414, P=.0309) post-intervention were also observed for the monitored medium-risk antibiotics. Conclusions: The restriction of the high-risk antibiotics contributed to both a reduction in their use and a reduction in the incidence of CDI in the study site hospital. Time-series analysis can be utilized as a risk classification tool with utility in antibiotic stewardship design and quality improvement programmes.

KW - C. difficile infection

KW - Quality improvement

KW - Risk classification

KW - Time-series analysis

UR - http://www.scopus.com/inward/record.url?scp=84869384243&partnerID=8YFLogxK

U2 - 10.1093/jac/dks330

DO - 10.1093/jac/dks330

M3 - Article

VL - 67

SP - 2988

EP - 2996

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 12

M1 - dks330

ER -