Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile

Objectives The aim of this study was to determine the temporal relation between the use of antibiotics and alcohol-based hand rubs (ABHRs) and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. Methods An interventional time-series analysis was performed to evaluate the impact of two promotion campaigns on the consumption of ABHRs and to assess their effect on the incidence of non-duplicate clinical isolates of MRSA and C. difficile from February 2000 through September 2006. This analysis was combined with a transfer function model of aggregated data on antibiotic use. Results Consumption of ABHRs correlated with MRSA, but not with C. difficile. The final model demonstrated the immediate effect of the second hand hygiene promotion campaign and an additional temporal effect of fluoroquinolone (time lag, 1 month; i.e. antibiotic effect delayed for 1 month), macrolide (lag 1 and 4 months), broad-spectrum cephalosporins (lag 3, 4 and 5 months) and piperacillin/tazobactam (lag 3 months) use. The final model explained 57% of the MRSA variance over time. In contrast, the model for C. difficile showed only an effect for broad-spectrum cephalosporins (lag 1 month). Conclusions We observed an aggregate-level relation between the monthly MRSA incidence and the use of different antibiotic classes and increased consumption of ABHR after a successful hand hygiene campaign, while no association with ABHR use was detected for C. difficil

Temporal effects of antibiotic use and Clostridium difficile infections

Objectives We tested a previously published model for the analysis of the temporal relationship between antibiotic use and the incidence of Clostridium difficile infection in a hospital with stable incidence of infection at >1 case per 1000 admissions per month. Methods The study period was from April 2004 to June 2008 and used data from Infection Control and Hospital Pharmacy. We first described the monthly variation in C. difficile infection and then constructed a multivariate transfer function model that included lag time (cases of C. difficile infection in previous months and delays between changes in antibiotic use and changes in C. difficile infection). Results The average incidence of C. difficile infection was 1.5 cases per 1000 patients per month with no significant increase over 3 years. The number of cases of C. difficile infection in 1 month was dependent on the average number of cases of C. difficile infection in the previous 2 months. The models with data from the whole hospital showed a statistically significant relationship between the number of both hospital-acquired C. difficile infections and total C. difficile infections and consumption of piperacillin/tazobactam, ciprofloxacin and cefuroxime. The association between C. difficile infection and consumption of co-amoxiclav was only significant for hospital-acquired C. difficile infection. The model for hospital-acquired C. difficile infections explained 61% of the variance in C. difficile infections. Conclusions These results provide support for antibiotic policies that minimize the use of broad-spectrum penicillins (co-amoxiclav and piperacillin/tazobactam), cephalosporins and fluoroquinolone

Impact of Combined Low-Level Mupirocin and Genotypic Chlorhexidine Resistance on Persistent Methicillin-Resistant Staphylococcus aureus Carriage After Decolonization Therapy: A Case-control Study

The clinical significance of low-level mupirocin and genotypic chlorhexidine resistance remains unclear. This case-control study demonstrates that combined low-level mupirocin and genotypic chlorhexidine resistance significantly increases the risk of persistent MRSA carriage after decolonization therapy (OR 3.4, 95% CI 1.5-7.8

Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community

Objectives To determine the temporal relationship between antibiotic use and incidence of antibiotic-resistant Escherichia coli in both the inpatient and outpatient setting of a large urban area. Methods A retrospective observational time-series analysis was performed to evaluate the incidence of non-duplicate clinical isolates of E. coli resistant to ciprofloxacin, trimethoprim/sulfamethoxazole and cefepime from January 2000 through December 2007, combined with a transfer function model of aggregated data on antibiotic use in both settings obtained from the hospital's pharmacy and outpatient billing offices. Results Ciprofloxacin resistance increased from 6.0% (2000) to 15.4% (2007; P  < 0.0001) and cefepime resistance from 0.9% (2002) to 3.2% (2007; P= 0.01). Trimethoprim/sulfamethoxazole resistance remained stable (23.7%-25.8%). Total antibiotic use increased in both settings, while fluoroquinolone use increased significantly only among outpatients. A temporal effect between fluoroquinolone resistance in community E. coli isolates and outpatient use of ciprofloxacin (immediate effect and time lag 1 month) and moxifloxacin (time lag 4 months) was observed, explaining 51% of the variance over time. The incidence of cefepime resistance in E. coli was correlated with ciprofloxacin use in the inpatient (lag 1 month) and outpatient (lag 4 months) settings and with the use of ceftriaxone (lag 0 month), piperacillin/tazobactam (3 months) and cefepime (3 months) in the hospital (R2  = 51%). Conclusions These results support efforts to reduce prescribing of fluoroquinolones for control of resistant E. coli including extended-spectrum β-lactamase producers and show the added value of time-series analysis to better understand the interaction between community and hospital antibiotic prescribing and its spill-over effect on antibiotic resistanc

Multihospital Outbreak of Clostridium difficile Ribotype 027 Infection: Epidemiology and Analysis of Control Measures

Objective. To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak. Design. Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland. Interventions. Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene. Results. A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months; P = .003). Conclusion. These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillanc

Politique du médicament : modéliser l'efficience dans une perspective hospitalière et sociétale au moyen des time series

La Suisse suit le principe d'accès équitable au système de santé, de liberté pour le patient de choisir son médecin et liberté de prescription pour le médecin, malgré des contraintes économiques réelles et grandissantes. Nous avons exploré de nouvelles pistes pour allouer nos ressources de façon optimales non seulement en milieu hospitalier, mais aussi au sein de l'interaction d'un hôpital universitaire avec l'ambulatoire. Ainsi, nous avons mesuré notre campagne d'hygiène des mains sur le MRSA et le lien entre la consommation des antibiotiques sur la variation de la résistance de l'E.coli aux fluoroquinolones et au céfépime, dans une perspective sociétale. Nous avons aussi mesuré l'impact de la liste hospitalière restrictive des médicaments sur les coûts de la santé en ville. En conclusion, nous avons montré que modéliser l'efficience ne signifie pas dépenser moins, mais dépenser mieux

Life cycle of a drug – a perspective for policy makers

The interest in pharmaceutical agents is shared by key players pursuing the same general objective: to discover, test and treat patients. In this race, the pharmaceutical industries, regulatory bodies, physicians, patients, payers have various motivations, incentives and conflicting interests. As in most industrialised countries, Switzerland is expected to provide the best medicines to the largest number of patients using a limited budget, leaving the country struggling to reach a compromise between drug companies’ profit maximization and authorities’ cost containment issues. This thesis aims to describe the life cycle of a drug to give the reader a deeper knowledge of the key elements, different perspectives, and winning strategies that policy makers face when making highly valuable decisions

Accuracy of PubMed-based author lists of publications and use of author identifiers to address author name ambiguity: a cross-sectional study

Objective: To assess the accuracy of PubMed-based author lists of publications and use of author identifiers to address author name ambiguity. Methods: In this Swiss study conducted in 2019, 300 hospital-based senior physicians were asked to generate a list of their publications in PubMed and complete a questionnaire (type of query used, number of errors in their list of publications, knowledge and use of ORCID and ResearcherID). Results: 156 physicians (52%) agreed to participate, 145 of whom published at least one article (mean number of publications: 60 (SD 73)). Only 17% used the advanced search option. On average, there were 5 articles in the lists that were not co-authored by participants (advanced search: 1.0 (SD 2.6) vs. 5.9 (SD 13.9), p value 0.02) and 3 articles co-authored by participants that did not appear in the lists (advanced search: 1.5 (SD 2.0) vs. 3.6 (SD 8.4), p-value 0.05). Although 82% were aware of ORCID, only 16% added all their articles (39% and 6% respectively for ResearcherID). Conclusions: When used by senior physicians, the advanced search in PubMed is accurate for retrieving authors’ publications. Author identifiers are only used by a minority of physicians and are therefore not recommended in this context, as they would lead to inaccurate results

Gender gap in medical research: a bibliometric study in Swiss university hospitals

Several studies explored gender inequalities in research, but only limited data are available concerning general internal medicine and family medicine. We aimed to assess the level of gender inequalities in Swiss academic medical research. In this bibliometric study conducted in March 2020, we selected all senior hospital physicians practicing internal medicine or family medicine in the six Swiss university hospitals. The list of these physicians was extracted from the hospitals' websites. We recorded their socio-demographic characteristics. Then, using Web of Science, we retrieved the number of publications (overall, as first author, per year, per year as first author), the proportion of publications as first author, the number of citations (overall, per year, per publication) and the h-index, and we compared the data by gender. 367 senior physicians were included in the study [female physicians: 172 (47%), internal medicine: 187 (51%)]. Female physicians were four times less likely to be a professor (5% vs. 20%, p value < 0.001) and half as often heads of division or staff physicians (19% vs. 40%, p value < 0.001). The proportion of physicians having published at least one article was lower among women than men (79% vs. 90%, p value 0.003). Finally, all bibliometric indices were associated with male gender (incident rate ratios ranging from 1.9 [(95% CI 1.3–2.8), p value 0.001] for number of citations per publication to 9.3 [(95% CI 5.3–16.2), p value < 0.001] for number of citations), except the proportion of publications as first author that was associated with female gender [odds ratio 1.7 (95% CI 1.2–2.3), p value 0.003). Our data suggest a “leaky pipeline” phenomenon (a lower proportion of women moving up the academic ladder). In addition, with the exception of the proportion of publications as first author, all bibliometric indices were lower for female than male physicians