scholarly journals Changes in the Use of Broad-Spectrum Antibiotics after Cefepime Shortage: a Time Series Analysis

2011 ◽  
Vol 56 (2) ◽  
pp. 989-994 ◽  
Author(s):  
C. Plüss-Suard ◽  
A. Pannatier ◽  
C. Ruffieux ◽  
A. Kronenberg ◽  
K. Mühlemann ◽  
...  
Keyword(s):  
Time Series ◽  
Pseudomonas Aeruginosa ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Antibiotic Policy ◽  
Content Type ◽  
Broad Spectrum Antibiotics ◽  
Before And After ◽  
Alternative Antibiotic ◽  
The Impact

ABSTRACTThe original cefepime product was withdrawn from the Swiss market in January 2007 and replaced by a generic 10 months later. The goals of the study were to assess the impact of this cefepime shortage on the use and costs of alternative broad-spectrum antibiotics, on antibiotic policy, and on resistance ofPseudomonas aeruginosatoward carbapenems, ceftazidime, and piperacillin-tazobactam. A generalized regression-based interrupted time series model assessed how much the shortage changed the monthly use and costs of cefepime and of selected alternative broad-spectrum antibiotics (ceftazidime, imipenem-cilastatin, meropenem, piperacillin-tazobactam) in 15 Swiss acute care hospitals from January 2005 to December 2008. Resistance ofP. aeruginosawas compared before and after the cefepime shortage. There was a statistically significant increase in the consumption of piperacillin-tazobactam in hospitals with definitive interruption of cefepime supply and of meropenem in hospitals with transient interruption of cefepime supply. Consumption of each alternative antibiotic tended to increase during the cefepime shortage and to decrease when the cefepime generic was released. These shifts were associated with significantly higher overall costs. There was no significant change in hospitals with uninterrupted cefepime supply. The alternative antibiotics for which an increase in consumption showed the strongest association with a progression of resistance were the carbapenems. The use of alternative antibiotics after cefepime withdrawal was associated with a significant increase in piperacillin-tazobactam and meropenem use and in overall costs and with a decrease in susceptibility ofP. aeruginosain hospitals. This warrants caution with regard to shortages and withdrawals of antibiotics.

A comparison of global suicide terrorism by region before and after 9/11 terrorist attacks

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ahmet Guler ◽  
Mustafa Demir
Keyword(s):  
Time Series ◽  
Interrupted Time Series ◽  
Sub Saharan Africa ◽  
Terrorist Attacks ◽  
Suicide Terrorism ◽  
Content Type ◽  
The World ◽  
Before And After ◽  
Sub Saharan ◽  
Global Terrorism Database

Purpose This study aims to examine the effect of the 9/11 terrorist attacks on suicide terrorism in different regions of the world and changes in the trends in suicide terrorism according to regions before and after 9/11. Design/methodology/approach Using the data obtained from the Global Terrorism Database from 1981 to 2019, the descriptive statistics were computed first and then, independent samples t-tests were run to compare the monthly mean percentage of suicide-terrorism incidents that occurred in each region between the pre-9/11 and the post-9/11 periods. Finally, to statistically assess the effect of the 9/11 attacks and changes in the trends for the dependent variables over time, monthly interrupted time-series analyzes were conducted. Findings The results of monthly interrupted time series analyzes showed that after the 9/11 attacks, the trends for suicide-terrorism rates decreased significantly in three regions including South Asia, the Middle East and North Africa and Europe, while the trend for suicide-terrorism rates increased significantly in Sub-Saharan Africa. However, no statistically significant changes in the trends in suicide-terrorism rates occurred in three regions including North America, East Asia and Central Asia and Southeast Asia before 9/11, during November 2001 or after 9/11. Originality/value This study indicates the critical importance of the 9/11 terrorist attacks in suicide terrorism and its impact on these events in different regions of the world. The research also provides some recommendations concerning the effectiveness of defensive and offensive counterterrorism policies against suicide terrorism.

The Impact of a National Antimicrobial Stewardship Program on Antibiotic Prescribing in Primary Care: An Interrupted Time Series Analysis

2018 ◽  
Vol 69 (2) ◽  
pp. 227-232 ◽  
Author(s):  
Violeta Balinskaite ◽  
Alan P Johnson ◽  
Alison Holmes ◽  
Paul Aylin
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Series Data ◽  
Antibiotic Prescribing ◽  
Segmented Regression ◽  
Broad Spectrum Antibiotic ◽  
Stewardship Program ◽  
The Impact

Abstract Background The Quality Premium was introduced in 2015 to financially reward local commissioners of healthcare in England for targeted reductions in antibiotic prescribing in primary care. Methods We used a national antibiotic prescribing dataset from April 2013 until February 2017 to examine the number of antibiotic items prescribed, the total number of antibiotic items prescribed per STAR-PU (specific therapeutic group age/sex-related prescribing units), the number of broad-spectrum antibiotic items prescribed, and broad-spectrum antibiotic items prescribed, expressed as a percentage of the total number of antibiotic items. To evaluate the impact of the Quality Premium on antibiotic prescribing, we used a segmented regression analysis of interrupted time series data. Results During the study period, over 140 million antibiotic items were prescribed in primary care. Following the introduction of the Quality Premium, antibiotic items prescribed decreased by 8.2%, representing 5933563 fewer antibiotic items prescribed during the 23 post-intervention months, as compared with the expected numbers based on the trend in the pre-intervention period. After adjusting for the age and sex distribution in the population, the segmented regression model also showed a significant relative decrease in antibiotic items prescribed per STAR-PU. A similar effect was found for broad-spectrum antibiotics (comprising 10.1% of total antibiotic prescribing), with an 18.9% reduction in prescribing. Conclusions This study shows that the introduction of financial incentives for local commissioners of healthcare to improve the quality of prescribing was associated with a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care in England.

scholarly journals Assessing the impact of retraction on the citation of randomized controlled trial reports: an interrupted time-series analysis

2018 ◽  
Vol 24 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Andrew Mott ◽  
Caroline Fairhurst ◽  
David Torgerson
Keyword(s):  
Time Series ◽  
Randomized Controlled Trial ◽  
Randomized Controlled Trials ◽  
Controlled Trial ◽  
Interrupted Time Series ◽  
Controlled Trials ◽  
Interrupted Time Series Analysis ◽  
Randomized Controlled ◽  
Before And After ◽  
The Impact

Objectives To assess the impact of retraction on the citation of randomized controlled trials. Methods We used an interrupted time-series with matched controls. PubMed, CINHAL, Google and the Retraction Watch Database were searched. We identified retracted publications reporting the results of randomized controlled trials involving human participants with two years of available data before and after retraction. We obtained monthly citation counts across all articles for the 24 months before and after retraction, from Web of Science. We used a Poisson segmented regression to detect changes in the level and trend of citation following retraction. We also undertook a matched control analysis of unretracted randomized controlled trials and a sensitivity analysis to account for cases of large-scale, well-advertised fraud. Results We identified 387 retracted randomized controlled trial reports, of which 218 (56.3%) were included in the interrupted time-series analysis. A reduction of 22.9% (95% CI 4.0% to 38.2%, p = 0.02) was observed in the number of citations in the month after retraction, and a further reduction of 1.9% (95% CI 0.4% to 3.5%, p = 0.02) per month in the following 24 months, relative to the expected trend. There was no evidence of a statistically significant reduction among the matched controls. Authors with a large number of retractions saw a 48.2% reduction at the time of retraction (95% CI 17.7% to 67.3%, p = 0.01). Other cases had a more gradual reduction with no change at the time of retraction and a 1.8% reduction per month in the following 24 months (95% CI 0.2% to 3.4%, p = 0.03). Conclusions Retractions of randomized controlled trial reports can be effective in reducing citations. Other factors, such as the scale of the retractions and media attention, may play a role in the effectiveness of the reduction.

scholarly journals Outpatient Fluoroquinolone Use in Children, 2000–2018

2020 ◽  
Author(s):  
Rachael K Ross ◽  
Jeffrey S Gerber ◽  
Zachary I Willis ◽  
Adam L Hersh ◽  
Alan C Kinlaw
Keyword(s):  
Broad Spectrum ◽  
Clinical Characteristics ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Fill Rate ◽  
Outpatient Prescription ◽  
Broad Spectrum Antibiotics ◽  
Trends Over Time ◽  
Future Work ◽  
The Impact

Abstract Background While fluoroquinolones are commonly used in adults, the use in children has been low. Since 2000, there were 3 US Food and Drug Administration (FDA) Boxed warnings regarding fluoroquinolones (2008, 2013, and 2016). Our objective was to describe the use of fluoroquinolones in children and assess the impact of 3 recent FDA warnings on fluoroquinolone use. Methods From 2000 to 2018, we assessed claims for all outpatient prescription fills to measure the use of systemic fluoroquinolones and other broad-spectrum antibiotics in children  less than 18 years old in the MarketScan Commercial Claims and Encounters database. We describe demographics, indication for antibiotic, and clinical characteristics. To assess the impact of FDA warnings on fill rates, we conducted an interrupted time-series analysis. Results The cohort included 34.6 million unique beneficiaries less than 18 years old with 441 062 fluoroquinolone fills (5.5 fills per 1000 person-years). The fluoroquinolone fill rate was highest among children > 11 years old. Urinary tract infection was the most common associated diagnosis (21.8%). Since 2008, the fluoroquinolone fill rate has declined. By the end of the study period in December 2018, in the (counterfactual) absence of the FDA warnings, fluoroquinolone fill rate would have been 7.5 (95% confidence interval [CI]: 5.2-9.7); however, the corresponding rate in observed data was 2.8 (95% CI: 1.7-3.9). Conclusions Fluoroquinolone use was low compared with other common broad-spectrum antibiotics and declining trends over time were associated with FDA warnings, even though these warnings were not pediatric specific. Future work should assess the adverse events at issue in these warnings in children.

Interrupted Time-Series Analysis to Evaluate the Impact of a National Antimicrobial Stewardship Campaign on Antibiotic Prescribing: A Typical Practice in China’s Primary Care

2020 ◽  
Author(s):  
Hui Li ◽  
Yanhong Gong ◽  
Jing Han ◽  
Shengchao Zhang ◽  
Shanquan Chen ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Targeted Interventions ◽  
The Impact ◽  
Outpatient Prescriptions

Abstract Background After implementing the 2011 national antimicrobial stewardship campaign, few studies focused on evaluating its effect in China’s primary care facilities. Methods We randomly selected 11 community health centers in Shenzhen, China, and collected all outpatient prescriptions of these centers from 2010–2015. To evaluate the impact of local interventions on antibiotic prescribing, we used a segmented regression model of interrupted time series to analyze seven outcomes, i.e., percentage of prescriptions with antibiotics, and percentages of prescriptions with broad-spectrum antibiotics, with parenteral antibiotics, and with two or more antibiotics in all prescriptions or antibiotics-containing prescriptions. Results Overall, 1 482 223 outpatient prescriptions were obtained. The intervention was associated with a significant immediate change (–5.2%, P=.04) and change in slope (–3.1% per month, P<.01) for the percentage of prescriptions with antibiotics, and its relative cumulative effect at the end of the study was –74.0% (95% confidence interval, –79.0% to –69.1%). After the intervention, the percentage of prescriptions with broad-spectrum, and with parenteral antibiotics decreased dramatically by 36.7% and 77.3%, respectively, but their percentages in antibiotic-containing prescriptions decreased insignificantly. Percentage of prescriptions with two or more antibiotics in all prescriptions or antibiotics-containing prescriptions only showed immediate changes, but significant changes in slope were not observed. Conclusions A typical practice in Shenzhen, China, showed that strict enforcement of antimicrobial stewardship campaign could effectively reduce antibiotic prescribing in primary care with a stable long-term effect. However, prescribing of broad-spectrum and parenteral antibiotics was still prevalent. More targeted interventions are required to promote appropriate antibiotic use.

scholarly journals Impact of Antibiotic Use on Carbapenem Resistance in Pseudomonas aeruginosa: Is There a Role for Antibiotic Diversity?

2013 ◽  
Vol 57 (4) ◽  
pp. 1709-1713 ◽  
Author(s):  
C. Plüss-Suard ◽  
A. Pannatier ◽  
A. Kronenberg ◽  
K. Mühlemann ◽  
G. Zanetti
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Broad Spectrum ◽  
Carbapenem Resistance ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Content Type ◽  
Defined Daily Doses ◽  
Consumption Data ◽  
Resistance Rates ◽  
The Impact

ABSTRACTIn this study, we aimed to evaluate the relationship between the rates of resistance ofPseudomonas aeruginosato carbapenems and the levels and diversity of antibiotic consumption. Data were retrospectively collected from 20 acute care hospitals across 3 regions of Switzerland between 2006 and 2010. The main outcome of the present study was the rate of resistance to carbapenems amongP. aeruginosa. Putative predictors included the total antibiotic consumption and carbapenem consumption in defined daily doses per 100 bed days, the proportion of very broad-spectrum antibiotics used, and the Peterson index. The present study confirmed a correlation between carbapenem use and carbapenem resistance rates at the hospital and regional levels. The impact of diversifying the range of antibiotics used againstP. aeruginosaresistance was suggested by (i) a positive correlation in multivariate analysis between the above-mentioned resistance and the proportion of consumed antibiotics having a very broad spectrum of activity (coefficient = 1.77; 95% confidence interval, 0.58 to 2.96;P< 0.01) and (ii) a negative correlation between the resistance and diversity of antibiotic use as measured by the Peterson homogeneity index (coefficient = −0.52;P< 0.05). We conclude that promoting heterogeneity plus parsimony in the use of antibiotics appears to be a valuable strategy for minimizing the spread of carbapenem resistance inP. aeruginosain hospitals.

CRASH and burn: abatement of a specialised gang unit

2016 ◽  
Vol 2 (2) ◽  
pp. 95-106 ◽  
Author(s):  
Matthew Valasik ◽  
Shannon E. Reid ◽  
Matthew D. Phillips
Keyword(s):  
Time Series ◽  
Los Angeles ◽  
Community Policing ◽  
Design Methodology ◽  
Interrupted Time Series ◽  
Gang Members ◽  
Content Type ◽  
The Impact ◽  
Time Series Methodology ◽  
Field Interview

Purpose – The purpose of this paper is to examine the impact of the temporary disbandment of a gang unit on collecting gang intelligence and arresting gang members in one of the Los Angeles Police Department’s Community Policing Areas. Design/methodology/approach – An interrupted time series methodology (ARIMA) is utilised to examine 1,429 field interview cards and 1,174 arrests of gang members that occurred from 1 January 2010 to 31 December 2011 within one police division. Findings – Results indicated that the dismantling of the gang unit negatively impacted the collection of intelligence on gang members by officers, regardless of whether the officers were officially serving in the gang unit. Suppression efforts by gang unit officers also resulted in a sustained decline. Originality/value – Given that many urban centres have specialised gang units, this study demonstrates how organisational turnover or disbandment of a gang unit negatively impacts a department’s ability to deal with local gang issues. Furthermore, these finding suggest that police organisations should consider such ramifications on intelligence-based policing activities.

scholarly journals Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257993
Author(s):  
Sara Rossin ◽  
Elisa Barbieri ◽  
Anna Cantarutti ◽  
Francesco Martinolli ◽  
Carlo Giaquinto ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Clinical Pathways ◽  
Community Acquired Pneumonia ◽  
Broad Spectrum Antibiotics ◽  
Outpatient Group ◽  
Before And After ◽  
Tract Infections ◽  
The Impact

Introduction The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broad-spectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians’ awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. Aims This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with community-acquired pneumonia (CAP) before and after both CPs (2015 and 2019). Methods The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1–5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. Results A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients’ group’s broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group’s antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. Conclusions This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update.

scholarly journals Prescriber Variation in Relation to Prescribing Trends within the Preferred Drugs Initiative in Ireland (2012–2015): An Interrupted Time-Series Study Using Latent Curve Models

2019 ◽  
Vol 39 (3) ◽  
pp. 278-293
Author(s):  
Ronald D. McDowell ◽  
Kathleen Bennett ◽  
Frank Moriarty ◽  
Sarah Clarke ◽  
Michael Barry ◽  
...  
Keyword(s):  
Time Series ◽  
Interrupted Time Series ◽  
Pharmacy Claims ◽  
Prescribing Trends ◽  
Before And After ◽  
Latent Curve ◽  
Latent Curve Models ◽  
Enhance Patient Care ◽  
The Impact ◽  
Series Study

Objectives. To examine the impact of the Preferred Drugs Initiative (PDI), an Irish health policy aimed at reducing prescribing variation. Design. Interrupted time series spanning 2012 to 2015. Setting. Health Service Executive pharmacy claims data for General Medical Services (GMS) patients, approximately 40% of the Irish population. Participants. Prescribers issuing preferred drug group items to GMS adults before and after PDI guidelines. Primary Outcome. The percentage coverage of PDI medications within each drug class per calendar quarter per prescriber. Methods. Latent curve models with structured residuals (LCM-SRs) were used to model coverage of the preferred drugs over time. The number of GMS adults receiving medication and the percentage who were 65 years and older at the start of the study were included as covariates. Results. In the quarter following PDI guidelines, coverage of the preferred drugs increased most in absolute terms for proton pump inhibitors (PPIs) (1.50% [SE 0.15], P < 0.001) and selective and norepinephrine reuptake inhibitors (SNRIs) (1.17% [SE 0.26], P < 0.001). Variation between prescribers remained relatively unchanged and increased for urology medications. Prescribers who increased coverage of the preferred PPI also increased coverage of the preferred statin immediately following guidelines (correlation 0.47 [SE 0.13], P < 0.001). Where guidelines were disseminated simultaneously, coverage of one preferred drug did not significantly predict coverage of the other preferred drug in the next calendar quarter. Prescribing of preferred drugs was not moderated by prescriber-level factors. Conclusions. Modest changes in prescribing of the preferred drugs have been observed over the course of the PDI. However, the guidelines have had little impact in reducing variation between prescribers. Further strategies may be necessary to reduce variation in clinical practice and enhance patient care.

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