scholarly journals Immediate and lasting impact of combining restrictive and enabling interventions to reduce aztreonam consumption in a community hospital

2021 ◽  
Author(s):  
Dviti Mody ◽  
Christopher Burke ◽  
Quentin Minson
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Community Hospital ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Beta Lactams ◽  
Post Intervention ◽  
Adult Intensive Care Unit ◽  
Defined Daily Doses ◽  
Long Term Impact

Abstract Background. Antimicrobial stewardship initiatives combining restrictive and enabling components may be an effective strategy to achieve short- and long-term objectives. Aztreonam, a relatively high-cost antipseudomonal antibiotic, is an appropriate target for stewardship initiatives based on propensity for overuse in penicillin allergy, an activity profile often warranting additional empiric gram-negative and gram-positive coverage, and a unique durability to Ambler class B metallo-beta-lactamases.Objective. Analyze the immediate and long-term impact on aztreonam prescribing of combining restrictive and enabling interventions.Setting. Single 233-bed community hospital with 45 adult intensive care unit beds in Nashville, Tennessee.Method. Retrospective, interrupted time series analysis comparing all patients receiving aztreonam prior to intervention between January 1, 2010 and September 30, 2011 and following intervention between October 1, 2011 and September 30, 2019. Quarterly defined daily doses/1000 adjusted patient days and microbiology laboratory annual surveillance data were utilized for analysis. Main outcome measure. Post-intervention change in trend of aztreonam consumption. Results. Following intervention, a significant decline in aztreonam consumption was observed (-1.97 defined daily doses/1000 adjusted patient days; p = 0.003) resulting in a sustained decrease in aztreonam consumption from 2011 (3rd quarter) to 2019 (3rd quarter) from 15.2 to 0.26 defined daily doses/1000 adjusted patient days. Short-term group 2 carbapenem consumption increased (p = 0.044). Pseudomonas aeruginosa susceptibility to aztreonam improved from 2011 to 2018 (72% vs. 84%; p = 0.0004) without deleterious effects to alternative antipseudomonal beta-lactams. Conclusion. Combining restrictive and enabling interventions had immediate and sustained impact on aztreonam consumption with Pseudomonas aeruginosa susceptibility improvement.Impacts on practice: ● A pharmacist-driven intervention combining restrictive and enabling strategies produced an immediate and sustained decrease in aztreonam prescribing at a community hospital.● Following the sustained reduction of aztreonam consumption, susceptibility rates for Pseudomonas aeruginosa improved without producing deleterious effects on alternative antipseudomonal beta-lactams.

scholarly journals Short- and Long-Term Impact of a Multifaceted Approach Targeting Fluoroquinolone use in a Tertiary, Non-Teaching Hospital

2022 ◽  
Author(s):  
Brianna Belsky ◽  
Quentin Minson
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Teaching Hospital ◽  
Interrupted Time Series ◽  
Antibiotic Consumption ◽  
Interrupted Time Series Analysis ◽  
Short Term ◽  
Multifaceted Approach ◽  
Defined Daily Doses ◽  
The Impact

Abstract Background. While various strategies for antibiotic restrictions have been validated, their impacts are not well described in smaller, non-teaching facilities. Fluoroquinolones are an appropriate target for restriction based on their propensity for overuse and potential for causing “collateral damage.” Aim. Evaluate the impact of a multifaceted approach to decreasing fluoroquinolone use on fluoroquinolones and alternative antibiotics at a smaller, non-teaching facility. Method. Retrospective, interrupted time series analysis conducted at a single 288-bed, tertiary, non-teaching hospital with 71 adult ICU beds comparing antibiotic consumption measured monthly by defined daily doses per 1000 adjusted patient days (DDD/1000 APD) prior to intervention (January 2011 to August 2014) to short-term (October 2014 to December 2015) and long-term (January 2018 to December 2019) periods following intervention. Results. An increase in downward trends of fluoroquinolone use was observed from prior to intervention (-0.49 DDD/1000 APD) to the short-term period (-1.13 DDD/1000 APD) and to a greater extent in the long-term period following the intervention (-1.32 DDD/1000 APD). Fluoroquinolone consumption decreased from 100.20 DDD/1000 APD in August 2014 to 73.96 DDD/1000 APD in the short-term and 14.89 DDD/1000 APD in the long-term intervention period. Levofloxacin susceptibility for Pseudomonas aeruginosa increased from 61% in 2014 to 83% in 2018. No deleterious effects on Pseudomonas aeruginosa susceptibilities were observed for alternative antibiotics. Conclusion. A multifaceted approach to decreasing fluoroquinolone use at a smaller, tertiary, non-teaching hospital led to a sustained decrease in consumption and a substantial increase in levofloxacin susceptibility to Pseudomonas aeruginosa.

scholarly journals Improving Quinolone Use in Hospitals by Using a Bundle of Interventions in an Interrupted Time Series Analysis

2010 ◽  
Vol 54 (9) ◽  
pp. 3763-3769 ◽  
Author(s):  
Ina Willemsen ◽  
Ben Cooper ◽  
Carin van Buitenen ◽  
Marjolein Winters ◽  
Gunnar Andriesse ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Interrupted Time Series ◽  
Resistance Rate ◽  
Hospitalized Patients ◽  
Quinolone Resistance ◽  
Interrupted Time Series Analysis ◽  
Active Monitoring ◽  
Targeted Interventions ◽  
Defined Daily Doses ◽  
Stepwise Reduction

ABSTRACT The objectives of the present study were to determine the effects of multiple targeted interventions on the level of use of quinolones and the observed rates of resistance to quinolones in Escherichia coli isolates from hospitalized patients. A bundle consisting of four interventions to improve the use of quinolones was implemented. The outcome was measured from the monthly levels of use of intravenous (i.v.) and oral quinolones and the susceptibility patterns for E. coli isolates from hospitalized patients. Statistical analyses were performed using segmented regression analysis and segmented Poisson regression models. Before the bundle was implemented, the annual use of quinolones was 2.7 defined daily doses (DDDs)/100 patient days. After the interventions, in 2007, this was reduced to 1.7 DDDs/100 patient days. The first intervention, a switch from i.v. to oral medication, was associated with a stepwise reduction in i.v. quinolone use of 71 prescribed daily doses (PDDs) per month (95% confidence interval [CI] = 47 to 95 PDDs/month, P < 0.001). Intervention 2, introduction of a new antibiotic guideline and education program, was associated with a stepwise reduction in the overall use of quinolones (reduction, 107 PDDs/month [95% CI = 58 to 156 PDDs/month). Before the interventions the quinolone resistance rate was increasing, on average, by 4.6% (95% CI = 2.6 to 6.1%) per year. This increase leveled off, which was associated with intervention 2 and intervention 4, active monitoring of prescriptions and feedback. Trends in resistance to other antimicrobial agents did not change. This study showed that the hospital-wide use of quinolones can be significantly reduced by an active policy consisting of multiple interventions. There was also a stepwise reduction in the rate of quinolone resistance associated with the bundle of interventions.

Antibiotic Resistance in Pseudomonas aeruginosa Related to Quinolone Formulary Changes: An Interrupted Time Series Analysis

2011 ◽  
Vol 32 (4) ◽  
pp. 400-402 ◽  
Author(s):  
E. Chandler Church ◽  
Patrick D. Mauldin ◽  
John A. Bosso
Keyword(s):  
Pseudomonas Aeruginosa ◽  
South Carolina ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Interrupted Time Series Analysis ◽  
University Of South Carolina ◽  
Development Of Resistance

Pseudomonas aeruginosa is a nosocomial pathogen capable of exhibiting a variety of resistance mechanisms against multiple classes of antibiotics. Fluoroquinolones, commonly used to treat a variety of infections in both ambulatory and hospitalized patients, have been increasingly linked to the development of resistance, both to fluoroquinolones and to other classes of antibiotics including β-lactams, cephalosporins, and carbapenems. In turn, as many as 95% of multidrug-resistant pseudomonal isolates may be resistant to fluoroquinolones. Although research has examined the effect of fluoroquinolone use on P. aeruginosa resistance, to our knowledge, no work has been published describing possible differences among individual fluoroquinolones related to resistance to other antibiotic classes. The purpose of this analysis was to assess the possible effects of varying usage of levofloxacin, gatifloxacin, and moxifloxacin on P. aeruginosa susceptibility to piperacillin-tazobactam, cefepime, and tobramycin. Data from January 2000 through December 2008 were obtained from clinical microbiology and pharmacy databases of the Medical University of South Carolina Medical Center, which is a 689-bed academic medical center and level 1 trauma center with adult and pediatric beds. This study was approved by the institution's institutional review board.

The Impact of the Change in Payment System for German Psychiatric Clinics on Treatment Success: An Interrupted Time Series Analysis

2019 ◽  
Vol 82 (06) ◽  
pp. 559-567
Author(s):  
Christina Niedermeier ◽  
Andrea Barrera ◽  
Eva Esteban ◽  
Ivana Ivandic ◽  
Carla Sabariego
Keyword(s):  
Time Series ◽  
Negative Impact ◽  
Treatment Success ◽  
Interrupted Time Series ◽  
Sensitivity Analyses ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Intervention Point ◽  
The Impact ◽  
New System

Abstract Background In Germany a new reimbursement system for psychiatric clinics was proposed in 2009 based on the § 17d KHG Psych-Entgeltsystem. The system can be voluntary implemented by clinics since 2013 but therapists are frequently afraid it might affect treatment negatively. Objectives To evaluate whether the new system has a negative impact on treatment success by analysing routinely collected data in a Bavarian clinic. Material and methods Aggregated data of 1760 patients treated in the years 2007–2016 was analysed with segmented regression analysis of interrupted time series to assess the effects of the system on treatment success, operationalized with three outcome variables. A negative change in level after a lag period was hypothesized. The robustness of results was tested by sensitivity analyses. Results The percentage of patients with treatment success tends to increase after the new system but no significant change in level was observed. The sensitivity analyses corroborate results for 2 outcomes but when the intervention point was shifted, the positive change in level for the third outcome became significant. Conclusions Our initial hypothesis is not supported. However, the sensitivity analyses disclosed uncertainties and our study has limitations, such as a short observation time post intervention. Results are not generalizable as data of a single clinic was analysed. Nevertheless, we show the importance of collecting and analysing routine data to assess the impact of policy changes on patient outcomes.

scholarly journals Effects of the implementation of a hand hygiene education program among ICU professionals: an interrupted time-series analysis

2019 ◽  
Vol 45 (5) ◽  
Author(s):  
Diana Marcela Prieto Romero ◽  
Maycon Moura Reboredo ◽  
Edimar Pedrosa Gomes ◽  
Cristina Martins Coelho ◽  
Maria Aparecida Stroppa de Paula ◽  
...  
Keyword(s):  
Time Series ◽  
Hand Hygiene ◽  
Education Program ◽  
Hand Hygiene Compliance ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Intervention Phase ◽  
Hygiene Compliance ◽  
Hygiene Education

ABSTRACT Objective: To evaluate the effects that a hand hygiene education program has on the compliance of health professionals in an ICU. Methods: This was a quasi-experimental study with an interrupted time-series design, conducted over a 12-month period: the 5 months preceding the implementation of a hand hygiene education program (baseline period); the 2 months of the intensive (intervention) phase of the program; and the first 5 months thereafter (post-intervention phase). Hand hygiene compliance was monitored by one of the researchers, unbeknownst to the ICU team. The primary outcome measure was the variation in the rate of hand hygiene compliance. We also evaluated the duration of mechanical ventilation (MV), as well as the incidence of ventilator-associated pneumonia (VAP) at 28 days and 60 days, together with mortality at 28 days and 60 days. Results: On the basis of 959 observations, we found a significant increase in hand hygiene compliance rates-from 31.5% at baseline to 65.8% during the intervention phase and 83.8% during the post-intervention phase, corresponding to prevalence ratios of 2.09 and 2.66, respectively, in comparison with the baseline rate (p < 0.001). Despite that improvement, there were no significant changes in duration of MV, VAP incidence (at 28 or 60 days), or mortality (at 28 or 60 days). Conclusions: Our findings indicate that a hand hygiene education program can increase hand hygiene compliance among ICU professionals, although it appears to have no impact on VAP incidence, duration of MV, or mortality.

The development and implementation of a discharge checklist for psychiatric inpatients: a pilot study

2018 ◽  
Vol 26 (3) ◽  
pp. 259-262 ◽  
Author(s):  
Yasmin Khanbhai ◽  
Michael Nance ◽  
David Smith
Keyword(s):  
Pilot Study ◽  
Discharge Planning ◽  
Psychiatric Inpatients ◽  
Interrupted Time Series ◽  
High Rate ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Readmission Rates ◽  
Implementation Period ◽  
Quasi Experimental

Objectives: Readmission rates are a routinely used measure of patient and service outcomes, potentially improved by discharge planning. This pilot study aimed to develop a discharge checklist for psychiatric inpatients, exploring its feasibility, applicability, and impact on readmission rates. Methods: The study used a quasi-experimental, pre–post intervention design. The checklist was designed from an evidence-based literature review, and introduced for a three-month period, comparing 28-day readmission rates with the previous three months using interrupted time series analysis. Results: Checklists were completed for 80% of patients in the trial period, with 100% completion of checklist items. Demographic and clinical details for pre- and post-intervention groups were closely aligned. There was a small, but statistically non-significant, reduction in readmission rates. Conclusions: There was a high rate of checklist completion. The lack of significant reductions in readmission rates supports more development of the checklist application and design before a longer implementation period and re-evaluation.

scholarly journals Long-Term Control of Endemic Hospital-Wide Methicillin-ResistantStaphylococcus aureus(MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

2010 ◽  
Vol 31 (8) ◽  
pp. 786-795 ◽  
Author(s):  
Jesus Jesús Rodríguez-Baño ◽  
Lola García ◽  
Encarnación Ramírez ◽  
Carmen Lupión ◽  
Miguel A. Muniain ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Healthcare Workers ◽  
Clinical Epidemiology ◽  
Tertiary Care ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Epidemiology Data ◽  
The Impact ◽  
Mrsa Colonization

Objective.To evaluate the long-term impact of successive interventions on rates of methicillin-resistantStaphylococcus aureus(MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation.Design.Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis.Setting.A 950-bed teaching hospital in Seville, Spain.Patients.All patients admitted to the hospital during the period from 1995 through 2008.Methods.Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers.Results.Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptibleS. aureusdid not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care.Conclusion.Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.

Sign in / Sign up

Export Citation Format

Share Document