scholarly journals Hospital ward design and prevention of hospital-acquired infections: A prospective clinical trial

2014 ◽  
Vol 25 (5) ◽  
pp. 265-270 ◽  
Author(s):  
Jennifer Ellison ◽  
Danielle Southern ◽  
Donna Holton ◽  
Elizabeth Henderson ◽  
Jean Wallace ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Controlled Trial ◽  
Care Facility ◽  
Hospital Ward ◽  
Incidence Density ◽  
Medical Patients ◽  
Hospital Acquired Infections ◽  
Hospital Acquired

BACKGROUND: Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections.OBJECTIVE: To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization.METHODS: A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple ‘historic design’ wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated ‘new design’ ward (predominantly single rooms with private bathrooms).RESULTS: Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient-days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single-bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient-days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30).CONCLUSIONS: No difference in the incidence density of hospital-acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single-bed versus multibed wings suggests that ward design warrants further study.

scholarly journals A Study on Hospital Acquired Infections among Patients in a Tertiary Care Hospital of Darjeeling District, West Bengal

2018 ◽  
Vol 26 (3) ◽  
pp. 197-206
Author(s):  
Maumita De ◽  
Diptanshu Mukherjee
Keyword(s):  
Incidence Rate ◽  
Bacterial Pathogens ◽  
Tertiary Care ◽  
Care Facility ◽  
Incidence Density ◽  
Care Hospital ◽  
Effective Prevention ◽  
Hospital Acquired Infections ◽  
Different Types ◽  
Hospital Acquired

Introduction Hospital Acquired Infections (HAI), also called ‘Nosocomial Infections’ are identified at least 48-72 hours following admission to health institution. In many hospitals, HAI appears to be a hidden, cross-cutting problem. Thus a continuous surveillance is imperative for determining the extent of the problem and its effective prevention and control. Present study determines the incidence and different types of hospital acquired infections and the bacterial pathogens responsible for those. Materials and Methods An observational longitudinal study was undertaken during January to June 2014, among 107 patients admitted in ENT wards of North Bengal Medical College and Hospital (NBMCH), selected by consecutive inclusion technique. Information was taken using a predesigned, pretested semi-structured schedule. The collected data were analyzed as frequencies, percentages and means ± standard deviations. Results The present study found incidence rate of hospital acquired infections as 19.6% and incidence density as 26.35 per 1000 patient days. Surgical site infection was commonest type (57.2%) followed by urinary tract infection (23.8%) and blood stream infection (19.0%) respectively. 15.4% of blood cultures, 100.0% of surgical wound swab cultures and 21.7% of urine cultures were positive and gram negative bacteria were most frequently occurring organisms. Most commonly found bacteria were Pseudomonas and Klebsiella. Discussion Background characteristics of the study population; incidence rate, the different types of hospital acquired infections among those admitted patients and the bacterial pathogens responsible for those infections have been discussed along with review of literature. Conclusion Even if in a tertiary health care facility, hospital acquired infection rate could not be brought down into <10%. So implementation of stringent guidelines on prevention of HAI and continuous surveillance and monitoring system can help to diminish this problem in future.

Azithromycin distribution and childhood mortality in compliance-related subgroups in Niger: complier average causal effect and spillovers in a cluster-randomized, placebo-controlled trial

2021 ◽  
Author(s):  
Kieran S O’Brien ◽  
Ahmed M Arzika ◽  
Ramatou Maliki ◽  
Abdou Amza ◽  
Farouk Manzo ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Causal Effect ◽  
Controlled Trial ◽  
Effect Analysis ◽  
Intention To Treat ◽  
Average Causal Effect ◽  
Cluster Randomized ◽  
Complier Average Causal Effect

Abstract Background Biannual azithromycin distribution to children 1–59 months old reduced all-cause mortality by 18% [incidence rate ratio (IRR) 0.82, 95% confidence interval (CI): 0.74, 0.90] in an intention-to-treat analysis of a randomized controlled trial in Niger. Estimation of the effect in compliance-related subgroups can support decision making around implementation of this intervention in programmatic settings. Methods The cluster-randomized, placebo-controlled design of the original trial enabled unbiased estimation of the effect of azithromycin on mortality rates in two subgroups: (i) treated children (complier average causal effect analysis); and (ii) untreated children (spillover effect analysis), using negative binomial regression. Results In Niger, 594 eligible communities were randomized to biannual azithromycin or placebo distribution and were followed from December 2014 to August 2017, with a mean treatment coverage of 90% [standard deviation (SD) 10%] in both arms. Subgroup analyses included 2581 deaths among treated children and 245 deaths among untreated children. Among treated children, the incidence rate ratio comparing mortality in azithromycin communities to placebo communities was 0.80 (95% CI: 0.72, 0.88), with mortality rates (deaths per 1000 person-years at risk) of 16.6 in azithromycin communities and 20.9 in placebo communities. Among untreated children, the incidence rate ratio was 0.91 (95% CI: 0.69, 1.21), with rates of 33.6 in azithromycin communities and 34.4 in placebo communities. Conclusions As expected, this analysis suggested similar efficacy among treated children compared with the intention-to-treat analysis. Though the results were consistent with a small spillover benefit to untreated children, this trial was underpowered to detect spillovers.

scholarly journals “Universal test and treat” program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia

2020 ◽  
Author(s):  
Tadele Girum ◽  
Fedila Yasin ◽  
Samuel Dessu ◽  
Bereket Zeleke ◽  
Mulugeta Geremew
Keyword(s):  
Antiretroviral Therapy ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Incidence Density ◽  
South Ethiopia ◽  
Test And Treat ◽  
Universal Test ◽  
Universal Test And Treat ◽  
Adjusted Incidence

Abstract Background: Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV and at least 25% of deaths are attributed to TB. Many countries implement the Universal Test and Treat (UTT) program for HIV, which is believed to reduce the incidence of TB. However, there are limited studies that evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the “UTT” and “differed treatment” programs, we aim to measure the effect of the UTT program on TB incidence.Objective: To measure the effect of “UTT” program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage Zone, South Ethiopia.Methods: A retrospective cohort study was conducted through record review over 5 years (2014-2019) in public health facilities in Gurage Zone. 384 records were randomly selected and reviewed using a standardized structured checklist. Data was entered using Epi InfoTM Version 7 and analyzed by STATA. A generalized linear model with binomial link function was fitted to measure the adjusted incidence density/incidence rate ratio and to identify predictors of incidence difference between the two programs.Results: During the follow up period, 39 incident TB cases were identified with an overall incidence rate of 4.79/100 person-year (PY). TB incidence was significantly lower in the UTT cohort (IR=2.10/100 PY) in comparison to the differed program cohort (IR=6.23/100 PY). The adjusted incidence rate ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI=0.08-0.70). Thus, there was a reduction of TB incidence by 75% in the UTT program compared to differed program. In addition, IPT (isoniazid preventive therapy) use (AIRR= 0.35 (95% CI=0.22-0.48)), WHO Stage I and II (AIRR=0.70 (95% CI=0.61-0.94)) and higher base line CD4 count (AIRR=0.96 (95% CI=.94-0.99)) significantly reduced the incidence of TB. However, treatment failure increase the incidence (AIRR=5.8 (95% CI=1.93-8.46)). Conclusion: TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.

Antimicrobial Stewardship in a Long-Term Acute Care Hospital Using Offsite Electronic Medical Record Audit

2016 ◽  
Vol 37 (4) ◽  
pp. 433-439 ◽  
Author(s):  
Kirthana Beaulac ◽  
Silvia Corcione ◽  
Lauren Epstein ◽  
Lisa E. Davidson ◽  
Shira Doron
Keyword(s):  
Incidence Rate ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Acute Care Hospital ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Hospital Acquired

OBJECTIVETo offer antimicrobial stewardship to a long-term acute care hospital using telemedicine.METHODSWe conducted an uninterrupted time-series analysis to measure the impact of antimicrobial stewardship on hospital-acquired Clostridium difficile infection (CDI) rates and antimicrobial use. Simple linear regression was used to analyze changes in antimicrobial use; Poisson regression was used to estimate the incidence rate ratio in CDI rates. The preimplementation period was April 1, 2010–March 31, 2011; the postimplementation period was April 1, 2011–March 31, 2014.RESULTSDuring the preimplementation period, total antimicrobial usage was 266 defined daily doses (DDD)/1,000 patient-days (PD); it rose 4.54 (95% CI, −0.19 to 9.28) per month then significantly decreased from preimplementation to postimplementation (−6.58 DDD/1,000 PD [95% CI, −11.48 to −1.67]; P=.01). The same trend was observed for antibiotics against methicillin-resistant Staphylococcus aureus (−2.97 DDD/1,000 PD per month [95% CI, −5.65 to −0.30]; P=.03). There was a decrease in usage of anti-CDI antibiotics by 50.4 DDD/1,000 PD per month (95% CI, −71.4 to −29.2; P<.001) at program implementation that was maintained afterwards. Anti-Pseudomonas antibiotics increased after implementation (30.6 DDD/1,000 PD per month [95% CI, 4.9–56.3]; P=.02) but with ongoing education this trend reversed. Intervention was associated with a decrease in hospital-acquired CDI (incidence rate ratio, 0.57 [95% CI, 0.35–0.92]; P=.02).CONCLUSIONAntimicrobial stewardship using an electronic medical record via remote access led to a significant decrease in antibacterial usage and a decrease in CDI rates.Infect. Control Hosp. Epidemiol. 2016;37(4):433–439

scholarly journals “Universal test and treat” program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia

2020 ◽  
Author(s):  
Tadele Girum ◽  
Fedila Yasin ◽  
Samuel Dessu ◽  
Bereket Zeleke ◽  
Mulugeta Geremew
Keyword(s):  
Antiretroviral Therapy ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Incidence Density ◽  
South Ethiopia ◽  
Test And Treat ◽  
Universal Test ◽  
Universal Test And Treat ◽  
Adjusted Incidence

Abstract Background: Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV. At least 25% of deaths are attributed to TB. It is believed that, Universal test and treat (UTT) program for HIV reduces incidence of TB and most countries implement the program. However, there is limited study conducted to evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the “UTT” and “differed treatment” programs we aimed to measure the effect of the UTT program on incidence of TB.Objective: To measure the effect of “UTT” program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia.Methods: Health facility based retrospective cohort study through record review of 5 year (2014-2019) cohort was conducted in public facilities of Gurage Zone. Randomly selected 384 records were reviewed by using standardized structured checklist. Data was entered by Epi info version 7 and analyzed by STATA. Generalized Linear Model with binomial link function was fitted to measure adjusted incidence density/Incidence rate ratio and identify predictors of incidence difference between the two programs.Results: During the follow up period, 39 incident TB cases were occurred, and making the overall incidence rate of 4.79/100 person-year (PY). It is significantly lower in the UTT (IR=2.10/100 PY) than the differed program (IR=6.23/100 PY). The adjusted Incidence Rate Ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI=0.08-0.70) compared to patients enrolled in the differed program. Thus, UTT program reduce TB incidence by 75% compared to differed program. In addition to the program, IPT (isoniazid preventive therapy) use (AIRR= 0.35 (95% CI=0.22-0.48)), WHO Stage I and II (AIRR=0.70 (95% CI=0.61-0.94)) and higher Base line CD4 count (AIRR=0.96 (95% CI=.94-0.99)) significantly reduce incidence of TB. Whereas, treatment failure increase the incidence (AIRR=5.8 (95% CI=1.93-8.46)). Conclusion: TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.

scholarly journals “Universal test and treat” program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia

2020 ◽  
Author(s):  
Tadele Girum ◽  
Fedila Yasin ◽  
Samuel Dessu ◽  
Bereket Zeleke ◽  
Mulugeta Geremew
Keyword(s):  
Antiretroviral Therapy ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Incidence Density ◽  
South Ethiopia ◽  
Test And Treat ◽  
Universal Test ◽  
Universal Test And Treat ◽  
Adjusted Incidence

Abstract Background: Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV. At least twenty five percent of deaths are attributed to TB. It is believed that, Universal test and treat (UTT) program for HIV reduces incidence of TB and most countries implement the program. However, there is no study conducted to evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the “UTT” and “differed treatment/CD4 based” programs we aimed to measure the effect of the UTT program on incidence of TB. Objective: To measure the effect of “UTT” program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia. Methods: Health facility based retrospective cohort study through record review of 5 year (2014-2019) cohort was conducted in public facilities of Gurage Zone. Randomly selected 384 records were reviewed by using standardized structured checklist by trained professionals. Data was entered by Epi info version 7 and analyzed by STATA. Generalized Linear Model with binomial link function was fitted to measure adjusted incidence density/Incidence rate ratio and identify predictors of incidence difference between the two programs. Results: During the follow up period, 39 incident TB cases were occurred, and making the overall incidence rate of 4.79/100 person-year. It is significantly lower in the UTT (IR=2.10/100 person-year) than the differed program (IR=6.23/100 person-year). The adjusted Incidence Rate Ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI=0.08-0.70) compared to patients enrolled in the differed program. Thus, UTT program reduce TB incidence by 75%. In addition to the program, IPT use (AIRR= 0.35 (95% CI=0.22-0.48)), WHO Stage I and II (AIRR=0.70 (95% CI=0.61-0.94)) and higher Base line CD4 count (AIRR=0.96 (95% CI=.94-0.99)) significantly reduce incidence of TB. Whereas, treatment failure increase the incidence (AIRR=5.8 (95% CI=1.93-8.46)). Conclusion: TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.

scholarly journals Seasonal variation of hospital-acquired bloodstream infections: A national cohort study

2021 ◽  
pp. 1-7
Author(s):  
Koen Blot ◽  
Naïma Hammami ◽  
Stijn Blot ◽  
Dirk Vogelaers ◽  
Marie-Laurence Lambert
Keyword(s):  
Regression Analysis ◽  
Seasonal Variation ◽  
Urinary Tract ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Bloodstream Infections ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Hospital Acquired

Abstract Background: Hospital-acquired bloodstream infections (HABSIs) cause increased morbidity, mortality, and hospital costs that are partially preventable. HABSI seasonality has been described for gram-negative bacteria but has not been stratified per infection origin. Objective: To assess seasonality among all types of HABSIs and their associations with climate. Methods: Hospitals performing surveillance for at least 1 full calendar year between 2000 and 2014 were included. Mixed-effects negative binomial regression analysis calculated the peak-to-low monthly ratio as an adjusted HABSI incidence rate ratio (IRR) with 95% confidence intervals (CIs). Another regression model examined associations between HABSI rates and climate variables. These analyses were stratified by microorganism and infectious origin. Results: The study population included 104 hospitals comprising 44,111 HABSIs. Regression analysis identified an incidence rate ratio (IRR) peak in August for gram-negative HABSIs (IRR, 1.59; 95% CI, 1.49–1.71), CLABSIs (IRR, 1.49; 95% CI, 1.30–1.70), and urinary tract HABSI (IRR, 1.52; 95% CI, 1.34–1.74). The gram-negative incidence increased by 13.1% (95% CI, 9.9%–16.4%) for every 5°C increase in temperature. Seasonality was most present among E. coli, K. pneumoniae, E. cloacae, and the nonfermenters. Gram-positive and pulmonary HABSIs did not demonstrate seasonal variation. Conclusions: Seasonality with summer spikes occurred among gram-negative bacteria, CLABSIs, and urinary tract HABSIs. Higher ambient temperature was associated with gram-negative HABSI rates. The preventable causative factors for seasonality, such as the nurse-to-patient ratio, indoor room temperature or device-utilization, need to be examined to assess areas for improving patient safety.

scholarly journals Infectious events in patients with severe COVID-19: results of a cohort of patients with high prevalence of underlying immune defect

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anastasia Saade ◽  
Giulia Moratelli ◽  
Guillaume Dumas ◽  
Asma Mabrouki ◽  
Jean-Jacques Tudesq ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Cumulative Risk ◽  
Incidence Density ◽  
Hospital Acquired Infections ◽  
Underlying Malignancy ◽  
Single Center Study ◽  
High Prevalence ◽  
Immune Defect ◽  
Hospital Acquired

Abstract Background Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. Methods Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. Results We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18–35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8–13.9]. Incidence density of hospital-acquired infections was 125 [91–200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient’s severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20–53] vs. 12% [4–20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18–52] vs. 13% [1–25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. Conclusions In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.

Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

2021 ◽  
Author(s):  
Susanna Scharrer ◽  
Christian Primas ◽  
Sabine Eichinger ◽  
Sebastian Tonko ◽  
Maximilian Kutschera ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Fatal Bleeding ◽  
Adjusted Incidence Rate ◽  
Inflammatory Bowel ◽  
Adjusted Incidence

Abstract Background Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. Methods This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. Results We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. Conclusion The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.

scholarly journals Secrets of the hospital underbelly: abundance of antimicrobial resistance genes in hospital wastewater reflects hospital antimicrobial use and inpatient length of stay

2019 ◽  
Author(s):  
Meghan R. Perry ◽  
Bram van Bunnik ◽  
Luke McNally ◽  
Bryan Wee ◽  
Patrick Munk ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Length Of Stay ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Clinical Activity ◽  
Hospital Wastewater ◽  
Antimicrobial Consumption ◽  
Gene Abundance ◽  
Class Level

ABSTRACTIntroductionHospital wastewater is a potential major source of antimicrobial resistance (AMR). This study uses metagenomics to ask how abundances of AMR genes in hospital wastewater are related to clinical activity.MethodsSewage was collected over a 24-hour period from multiple wastewater collection points representing different specialties within a tertiary hospital site and simultaneously from community sewage works. High throughput shotgun sequencing was performed using Illumina HiSeq4000. AMR gene abundances were correlated to hospital antimicrobial usage (AMU), data on clinical activity and resistance prevalence in clinical isolates.FindingsMicrobiota and AMR gene composition varied between each collection point and overall AMR gene abundance was higher in hospital wastewater than in community influent. The composition of AMR genes correlated with microbiota composition (Procrustes analysis, p=0.002). Increased antimicrobial consumption at a class level was associated with higher AMR gene abundance within that class in wastewater (incidence rate ratio 2.80, C.I. 1.2-6.5, p=0.016). Prolonged average patient length of stay was associated with higher total AMR gene abundance in wastewater (incidence rate ratio 2.05, C.I. 1.39-3.01, p=0.0003). AMR gene abundance at a class level within hospital wastewater did not reflect resistance patterns in the 181 clinical isolates grown from hospital inpatients over the time of wastewater sampling.ConclusionsHospital antimicrobial consumption and patient length of stay are important drivers of AMR gene outflow into the environment. Using metagenomics to identify the full range of AMR genes in hospital wastewater could represent a useful surveillance tool to monitor hospital AMR gene outflow and guide environmental policy on AMR.

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