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Changes in antibiotic consumption, AMR and Clostridioides difficile infections in a large tertiary-care center following the implementation of institution-specific guidelines for antimicrobial therapy: A nine-year interrupted time series study.
- Source :
-
PloS one [PLoS One] 2021 Oct 14; Vol. 16 (10), pp. e0258690. Date of Electronic Publication: 2021 Oct 14 (Print Publication: 2021). - Publication Year :
- 2021
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Abstract
- Background: Institution-specific guidelines (ISGs) within the framework of antimicrobial stewardship programs offer locally tailored decision support taking into account local pathogen and resistance epidemiology as well as national and international guidelines.<br />Objectives: To assess the impact of ISGs for antimicrobial therapy on antibiotic consumption and subsequent changes in resistance rates and Clostridioides difficile infections (CDIs).<br />Methods: The study was conducted at the Leipzig University Hospital, a 1,451-bed tertiary-care medical center, and covered the years 2012 to 2020. Since 2014, ISGs were provided to optimize empirical therapies, appropriate diagnostics, and antimicrobial prophylaxis. We used interrupted time series analysis (ITSA) and simple linear regression to analyze changes in antimicrobial consumption, resistance and CDIs.<br />Results: Over the study period, 1,672,200 defined daily doses (DDD) of antibiotics were dispensed, and 85,645 bacterial isolates as well as 2,576 positive C. difficile cultures were collected. Total antimicrobial consumption decreased by 14% from 2012 to 2020, without clear impact of the deployment of ISGs. However, implementation of ISGs was associated with significant decreases in the use of substances that were rarely recommended (e.g., fluoroquinolones). Over the whole study period, we observed declining resistance rates to most antibiotic classes of up to 25% in Enterobacterales, staphylococci, and Pseudomonas aeruginosa. Switching from ceftriaxone to cefotaxime was associated with reduced resistance to third-generation cephalosporins. The number of CDI cases fell by 65%, from 501 in 2012 to 174 in 2020.<br />Conclusions: Well-implemented ISGs can have a significant, immediate, and lasting impact on the prescription behavior. ISGs might thereby contribute to reduce resistance rates and CDI incidences in the hospital setting.<br />Competing Interests: The authors have declared that no competing interests exist.
- Subjects :
- Anti-Bacterial Agents pharmacology
Clostridioides difficile drug effects
Enterobacteriaceae drug effects
Germany
Humans
Interrupted Time Series Analysis
Linear Models
Practice Guidelines as Topic
Pseudomonas aeruginosa drug effects
Staphylococcus drug effects
Tertiary Care Centers
Antimicrobial Stewardship organization & administration
Clostridioides difficile growth & development
Clostridium Infections drug therapy
Drug Resistance, Bacterial
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 16
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 34648594
- Full Text :
- https://doi.org/10.1371/journal.pone.0258690