Incidence of healthcare-associated Clostridioides difficile infections and association with ward-level antibiotic consumption in a German university hospital: an ecological study

2019 ◽  
Vol 74 (8) ◽  
pp. 2400-2404 ◽  
Author(s):  
Marina Kipnis ◽  
Frank Schwab ◽  
Tobias S Kramer ◽  
Miriam S Stegemann ◽  
Caroline Isner ◽  
...  
Keyword(s):  
Risk Factor ◽  
Generation Cephalosporin ◽  
Antibiotic Consumption ◽  
University Hospital ◽  
Incidence Density ◽  
Third Generation ◽  
Antimicrobial Consumption ◽  
Clostridioides Difficile ◽  
Ward Level ◽  
Healthcare Associated

Abstract Objectives Clostridioides difficile infection (CDI) is one of the most important healthcare-associated infections. We aimed to describe the incidence density of healthcare-associated CDI (HA-CDI) in Germany’s largest hospital and to identify associations with ward-level antimicrobial consumption. Methods We used surveillance data on CDI and antimicrobial consumption from 2014 to 2017 and analysed a potential association by means of multivariable regression analysis. Results We included 77 wards with 404998 admitted patients and 1850862 patient-days. Six hundred and seventy-one HA-CDI cases were identified, resulting in a pooled mean incidence density of 0.36/1000 patient-days (IQR = 0.34–0.39). HA-CDI incidence density on ICU and haematological–oncological wards was about three times higher than on surgical wards [incidence rate ratio (IRR) = 3.00 (95% CI = 1.96–4.60) and IRR = 2.78 (95% CI = 1.88–4.11), respectively]. Ward-level consumption of third-generation cephalosporins was the sole antimicrobial risk factor for HA-CDI. With each DDD/100 patient-days administered, a ward’s HA-CDI incidence density increased by 2% [IRR = 1.02 (95% CI = 1.01–1.04)]. Other risk factors were contemporaneous community-associated CDI cases [IRR = 1.32 (95% CI = 1.07–1.63)] and CDI cases in the previous month [IRR = 1.27 (95% CI = 1.07–1.51)]. Furthermore, we found a significant decrease in HA-CDI in 2017 compared with 2014 [IRR = 0.68 (95% CI = 0.54–0.86)]. Conclusions We confirmed that ward-level antimicrobial use influences HA-CDI and specifically identified third-generation cephalosporin consumption as a risk factor.

scholarly journals Higher incidence of adverse events in isolated patients compared with non-isolated patients: a cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035238
Author(s):  
Fátima Jiménez-Pericás ◽  
María Teresa Gea Velázquez de Castro ◽  
María Pastor-Valero ◽  
Carlos Aibar Remón ◽  
Juan José Miralles ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Primary Outcome ◽  
Incidence Rates ◽  
University Hospital ◽  
Incidence Density ◽  
Secondary Outcome ◽  
National Study ◽  
Exclusion Criteria ◽  
Healthcare Associated

ObjectiveTo determine whether isolated patients admitted to hospital have a higher incidence of adverse events (AEs), to identify their nature, impact and preventability.DesignProspective cohort study with isolated and non-isolated patients.SettingOne public university hospital in the Valencian Community (southeast Spain).ParticipantsWe consecutively collected 400 patients, 200 isolated and 200 non-isolated, age ≥18 years old, to match according to date of entry, admission department, sex, age (±5 years) and disease severity from April 2017 to October 2018. Exclusion criteria: patients age <18 years old and/or reverse isolation patients.Primary and secondary outcome measuresThe primary outcome as the AE, defined according to the National Study of Adverse Effects linked to Hospitalisation (Estudio Nacional Sobre los Efectos Adversos) criteria. Cumulative incidence rates and AE incidence density rates were calculated.ResultsThe incidence of isolated patients with AEs 16.5% (95% CI 11.4% to 21.6%) compared with 9.5% (95% CI 5.4% to 13.6%) in non-isolated (p<0.03). The incidence density of patients with AEs among isolated patients was 11.8 per 1000 days/patient (95% CI 7.8 to 15.9) compared with 4.3 per 1000 days/patient (95% CI 2.4 to 6.3) among non-isolated patients (p<0.001). The incidence of AEs among isolated patients was 18.5% compared with 11% for non-isolated patients (p<0.09). Among the 37 AEs detected in 33 isolated patients, and the 22 AEs detected in 19 non-isolated patients, most corresponded to healthcare-associated infections (HAIs) for both isolated and non-isolated patients (48.6% vs 45.4%). There were significant differences with respect to the preventability of AEs, (67.6% among isolated patients compared with 52.6% among non-isolated patients).ConclusionsAEs were significantly higher in isolated patients compared with non-isolated patients, more than half being preventable and with HAIs as the primary cause. It is essential to improve training and the safety culture of healthcare professionals relating to the care provided to this type of patient.

scholarly journals Correlation between antibiotic consumption and the incidence of healthcare facility-onset Clostridioides difficile infection: a retrospective chart review and analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Ji Hyun Yun ◽  
Ga Eun Park ◽  
Hyun Kyun Ki
Keyword(s):  
Risk Factor ◽  
Chart Review ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Healthcare Facility ◽  
Antibiotic Consumption ◽  
Time Interval ◽  
Clostridioides Difficile ◽  
Antibiotic Associated Diarrhea ◽  
Clostridioides Difficile Infection

Abstract Background Healthcare facility-onset Clostridioides difficile infection is the leading cause of antibiotic-associated diarrhea, and is associated with morbidity and mortality. The use of antibiotics is an important risk factor for healthcare facility-onset C. difficile infection. We evaluated the correlation between the incidence of healthcare facility-onset C. difficile infection and antibiotic consumption, according to antibiotic class. Methods Patients with healthcare facility-onset C. difficile infection from January 2017 to December 2018 at Konkuk University Medical Center (a tertiary medical center) were included. We evaluated changes in the incidence of healthcare facility-onset C. difficile infection and antibiotic consumption. The correlation between the incidence of healthcare facility-onset C. difficile infection and antibiotic consumption was evaluated two ways: without a time interval and with 1-month interval matching. Results A total of 446 episodes of healthcare facility-onset C. difficile infection occurred during the study period. The incidence of healthcare facility-onset C. difficile infection was 9.3 episodes per 10,000 patient-days, and increased significantly. We observed an increase in the consumption of β-lactam/β-lactamase inhibitors, and a decrease in the consumption of other classes of antibiotics, with a significant decrease in the consumption of fluoroquinolones, glycopeptides, and clindamycin (P = 0.01, P < 0.001, and P = 0.001, respectively). The consumption of β-lactam/β-lactamase inhibitors was independently correlated with the incidence of healthcare facility-onset C. difficile infection in the analysis without a time interval. When the analysis was conducted with 1-month interval matching, glycopeptide consumption was independently associated with the incidence of healthcare facility-onset C. difficile infection. Conclusions Despite the reduction in fluoroquinolone and clindamycin consumption, the incidence of healthcare facility-onset C. difficile infection increased during the study period, and was correlated with increased consumption of β-lactam/β-lactamase inhibitors. Reduced consumption of specific antibiotics may be insufficient to reduce the incidence of healthcare facility-onset C. difficile infection.

Hepatitis C Virus Infection in Employees of a Large University Hospital in Israel

2001 ◽  
Vol 22 (12) ◽  
pp. 754-761 ◽  
Author(s):  
Simona Sermoneta-Gertel ◽  
Milka Donchin ◽  
Ruth Adler ◽  
Mario Baras ◽  
Tamar Perlstein ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Hepatitis C ◽  
Occupational Exposure ◽  
Central Asia ◽  
University Hospital ◽  
Third Generation ◽  
Country Of Birth ◽  
Hospital Work ◽  
History Of

AbstractObjective:To assess whether hospital work constitutes a risk factor for hepatitis C virus (HCV) infection among employees of a large hospital in Israel.Design:Seroprevalence survey.Setting:A 1,006-bed, tertiary-care university hospital in Jerusalem.Participants:All 5,444 employees (18-65 years old) were eligible; 4,287 (79%) participated in the survey.Methods:Sera were tested for antibodies to HCV (anti-HCV) using a third-generation enzyme immunoassay. A third-generation strip immunoblot assay was used for confirmation. Participants were interviewed regarding their occupational history, and they completed a self-administered questionnaire covering history of non-occupational exposure to blood and country of birth. Other demographic information was obtained from the personnel department. Rates and odds ratios (ORs) were calculated, and multivariate logistic-regression analyses were performed to adjust for potential confounding variables.Results:Anti-HCV was found in 0.9% of employees (37/4,287; 95% confidence interval, 0.6-1.1), ranging from 0.1% among those born in Israel to 5.7% among those born in Central Asia. After age, gender, social status, country of birth, and history of blood transfusion were controlled for in a logistic regression, occupational exposure to blood ≥10 years was significantly associated with the presence of antibodies (OR, 2.6; P=.01). Presence of anti-HCV also was associated with country of birth (range: Israel OR, 1; West OR, 3.8 [P=.1]; Central Asia OR, 48.6 [P<.0001]) and history of blood transfusion (OR, 2.7; P=.01). No significant associations were found between anti-HCV and age, gender, social status, history of tattoo, acupuncture, current occupation, department, exposure to blood in current occupation, adherence to safety precautions, or history of percutaneous injury. The association with length of exposure was stronger (OR, 3.6; P=.01) when the same logistic regression was run excluding the outlier ethnic group of Central Asia.Conclusions:Hospital work does not seem to constitute a major risk factor for HCV infection in Israel today. A higher prevalence of anti-HCV among employees with longer versus shorter lengths of occupational exposure may be due to a cumulative effect of exposure over the years. Infection control efforts in recent years may have contributed to this association.

scholarly journals Trends in Antibiotic Consumption and Resistance in France Over 20 Years: Large and Continuous Efforts but Contrasting Results

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Jean Carlet ◽  
Vincent Jarlier ◽  
Jacques Acar ◽  
Olivier Debaere ◽  
Patrick Dehaumont ◽  
...  
Keyword(s):  
Antibiotic Consumption ◽  
Third Generation ◽  
Antimicrobial Consumption ◽  
Information Campaign ◽  
Gram Negative ◽  
E Coli ◽  
Public Campaign ◽  
Third Generation Cephalosporins ◽  
Positive Effect ◽  
Gram Positive Cocci

Abstract Background Antimicrobial resistance (AMR) is a serious threat to humanity. This paper describes the French efforts made since 2001 and presents data on antimicrobial consumption (AC) and AMR. Methods We gathered all data on AC and AMR recorded since 2001 from different national agencies, transferred on a regular basis to standardized European data on AC and resistance in both humans and animals. Results After a large information campaign implemented in France from 2001 to 2005 in humans, AC in the community decreased significantly (18% to 34% according to the calculation method used). It remained at the same level from 2005 to 2010 and increased again from 2010 to 2018 (8%). Contrasting results were observed for AMR. The resistance of Staphylococcus aureus decreased significantly. For gram-negative bacilli, the results were variable according to the microorganism. The resistance of Enterobacteriaceae to third-generation cephalosporins increased, remaining moderate for Escherichia coli (12% in 2017) but reaching 35% in the same year for Klebsiella pneumoniae. Resistance to carbapenems in those 2 microorganisms remained below 1%. Both global AC and resistance to most antibiotics decreased significantly in animals. Conclusions Antibiotic consumption decreased significantly in France after a large public campaign from 2001 to 2005, but this positive effect was temporary. The effect on AMR varied according to the specific microorganism: The effect was very impressive for gram-positive cocci, variable for gram-negative bacilli, and moderate for E. coli, but that for K. pneumoniae was of concern. The consumption of and resistance to antibiotics decreased significantly in animals.

scholarly journals An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 690
Author(s):  
Sayer Al-Azzam ◽  
Nizar Mahmoud Mhaidat ◽  
Hayaa A. Banat ◽  
Mohammad Alfaour ◽  
Dana Samih Ahmad ◽  
...  
Keyword(s):  
Marked Reduction ◽  
Clinical Characteristics ◽  
Antibiotic Consumption ◽  
Antimicrobial Use ◽  
Third Generation ◽  
Antimicrobial Consumption ◽  
Total Consumption ◽  
One Year ◽  
The Impact ◽  
Third Generation Cephalosporins

Coronavirus disease 2019 (COVID-19) has overlapping clinical characteristics with bacterial respiratory tract infection, leading to the prescription of potentially unnecessary antibiotics. This study aimed at measuring changes and patterns of national antimicrobial use for one year preceding and one year during the COVID-19 pandemic. Annual national antimicrobial consumption for 2019 and 2020 was obtained from the Jordan Food and Drug Administration (JFDA) following the WHO surveillance methods. The WHO Access, Watch, and Reserve (AWaRe) classification was used. Total antibiotic consumption in 2020 (26.8 DDD per 1000 inhabitants per day) decreased by 5.5% compared to 2019 (28.4 DDD per 1000 inhabitants per day). There was an increase in the use of several antibiotics during 2020 compared with 2019 (third generation cephalosporins (19%), carbapenems (52%), macrolides (57%), and lincosamides (106%)). In 2020, there was a marked reduction in amoxicillin use (−53%), while the use of azithromycin increased by 74%. National antimicrobial consumption of the Access group decreased by 18% from 2019 to 2020 (59.1% vs. 48.1% of total consumption). The use of the Watch group increased in 2020 by 26%. The study highlighted an increase in the use of certain antibiotics during the pandemic period that are known to be associated with increasing resistance. Efforts to enhance national antimicrobial stewardship are needed to ensure rational use of antimicrobials.

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