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 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 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.

scholarly journals The impact of “4+7” volume based drugs procurement on the volume, expenditures, and daily costs of antihypertensive drugs in Shenzhen, China: a interrupted time series analysis

2021 ◽  
Author(s):  
Ying Yang ◽  
Ruiwen Tong ◽  
Shicheng Yin ◽  
Lining Mao ◽  
Luxinyi Xu ◽  
...  
Keyword(s):  
Time Series ◽  
Antihypertensive Drugs ◽  
Linear Regression Analysis ◽  
Interrupted Time Series ◽  
Chinese Government ◽  
Policy Intervention ◽  
Interrupted Time Series Analysis ◽  
Drug Procurement ◽  
Defined Daily Doses ◽  
The Impact

Abstract Background: On January 2019, Chinese government implemented the first round of the National Centralized Drug Procurement (NCDP) pilot of 25 drugs in 4 municipalities and 7 sub-provincial cities in mainland China, referred to as “4+7” policy. In the “4+7” policy, 7 antihypertensive drugs were included. This study was conducted to evaluate the impact of “4+7” policy on the use of policy-related antihypertensive drugs. Method: This study applied single-group Interrupted Time Series (ITS) design. We used drug purchasing data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Antihypertensive drugs related to “4+7” policy were selected as study samples, including 7 antihypertensive drugs in the “4+7” List and 17 antihypertensive drugs that have an alternative relationship with the “4+7” List drugs in clinical use. Purchase volume, expenditures, and daily costs were selected as outcome variables, and were measured using Defined Daily Doses (DDDs), Chinese Yuan (CNY), and Defined Daily Drug cost (DDDc), respectively. Segmented linear regression analysis was employed to examine the change of outcome variables before and after the policy intervention. Results: As of December 31, 2019, the completion rate of the agreed purchase volume of the 7 bid-winning antihypertensive drugs reached 173.42% in Shenzhen. After “4+7” policy, the DDDc of bid-winning antihypertensive drugs significantly decreased by 63.79% (-1.30 CNY, 95% CI= -1.43 to -1.18, p<0.001), while the DDDc of non-winning (0.28 CNY, 95% CI= 0.11 to 0.46, p<0.01) and alternative (0.14 CNY, 95% CI= 0.03 to 0.25, p<0.05) antihypertensive drugs increased markedly. The volume of bid-winning antihypertensive drugs significantly increased by 1311.76% (3.12 million DDD, 95% CI= 2.14 to 4.10, p<0.001). The overall costs of the seven “4+7” List antihypertensive drugs significantly declined by 101.34% (-5.96 million CNY, 95% CI= -7.87 to -4.04, p<0.001) after policy intervention, with an absolute reduction of 36.37 million CNY compared with the pre-“4+7” period. Conclusion: An overall satisfying implementation effect was observed in Shenzhen. A preliminary positive policy effect of price cut and cost-saving was observed in the antihypertensive drug category. However, the DDDc of non-winning and alternative drugs increased after policy intervention, suggesting that the price monitoring and drug use management regarding NCDP policy-related drugs should be strengthened. Keywords: National Centralized Drug Procurement (NCDP); "4+7"; volume-based procurement; antihypertensive drugs; China

scholarly journals Impact of Critical Illness Insurance on the Burden of High-Cost Rural Residents in Central China: An Interrupted Time Series Study

2019 ◽  
Vol 16 (19) ◽  
pp. 3528 ◽  
Author(s):  
Lu Li ◽  
Junnan Jiang ◽  
Li Xiang ◽  
Xuefeng Wang ◽  
Li Zeng ◽  
...  
Keyword(s):  
Time Series ◽  
Critical Illness ◽  
Interrupted Time Series ◽  
Term Effect ◽  
Central China ◽  
Mutual Aid ◽  
Interrupted Time Series Analysis ◽  
Long Term Effects ◽  
The Impact

Critical illness insurance (CII) in China was introduced to protect high-cost groups from health expenditure shocks for the purpose of mutual aid. This study aimed to evaluate the impact of CII on the burden of high-cost groups in central rural China. Data were extracted from the basic medical insurance (BMI) hospitalization database of Xiantao City from January 2010 to December 2016. A total of 77,757 hospitalization records were included in our analysis. The out-of-pocket (OOP) expenses and reimbursement ratio (RR) were the two main outcome variables. Interrupted time series analysis with a segmented regression approach was adopted. Level and slope changes were reported to reflect short- and long-term effects, respectively. Results indicated that the number of high-cost inpatient visits, the average monthly hospitalization expenses, and OOP expenses per high-cost inpatient visit were increased after CII introduction. By contrast, the RR from BMI and non-reimbursable expenses ratio were decreased. The OOP expenses and RR covered by CII were higher than those uncovered. We estimated a significant level decrease in OOP expenses (p < 0.01) and rise in RR (p < 0.01), whereas the slope decreases of OOP expenses (p = 0.19) and rise of RR (p = 0.11) after the CII were non-significant. We concluded that the short-term effect of the CII policy is significant and contributes to decreasing OOP expenses and raising RR for high-cost groups, whereas the long-term effect is non-significant. These findings can be explained by increasing hospitalization expenses, many non-reimbursable expenses, low coverage for high-cost groups, and the unsustainability of the financing methods.

Education and devices to prevent blood and body fluid exposures

2019 ◽  
Vol 70 (1) ◽  
pp. 38-44 ◽  
Author(s):  
S Cheetham ◽  
H Ngo ◽  
J Liira ◽  
E Lee ◽  
C Pethrick ◽  
...  
Keyword(s):  
Body Fluid ◽  
Interrupted Time Series ◽  
Hospital Staff ◽  
Incidence Rates ◽  
Full Time ◽  
Interrupted Time Series Analysis ◽  
Short Term ◽  
Full Time Equivalent ◽  
Post Intervention ◽  
The Impact

Abstract Background Healthcare workers are at risk of blood and body fluid exposures (BBFE) while delivering care to patients. Despite recent technological advances such as safety-engineered devices (SEDs), these injuries continue to occur in healthcare facilities worldwide. Aims To assess the impact of an education and SEDs workplace programme on rates of reported exposures. Methods A retrospective cohort study, utilizing interrupted time series analysis to examine reported exposures between 2005 and 2015 at a 600-bed hospital in Perth, Western Australia. The hospital wards were divided into four cohorts. Results A total of 2223 records were available for analysis. The intervention was most effective for the first cohort, with significant improvements both short-term (reduction of 12 (95% CI 7–17) incidents per 1000 full-time equivalent (FTE) hospital staff) and long-term (reduction of 2 (CI 0.6–4) incidents per 1000 FTE per year). Less significant or consistent impacts were observed for the other three cohorts. Overall, the intervention decreased BBFE exposure rates at the hospital level from 19 (CI 18–20) incidents per 1000 FTE pre-intervention to 11 (CI 10–12) incidents per 1000 FTE post-intervention, a 41% reduction. No exposures resulted in a blood-borne virus infection. Conclusions The intervention was most effective in reducing exposures at a time when incidence rates were increasing. The overall effect was short-term and did not further reduce an already stabilized trend, which was likely due to improved safety awareness and practice, induced by the first cohort intervention.

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.

scholarly journals Lockdown effect on COVID-19 incidence and death: Iran experience

2021 ◽  
pp. 1-10
Author(s):  
Sajad Delavari ◽  
Zahra Jamali ◽  
Mohsen Bayati
Keyword(s):  
Social Interactions ◽  
Interrupted Time Series ◽  
World Health ◽  
Interrupted Time Series Analysis ◽  
Negative Effects ◽  
Short Term ◽  
Mortality And Morbidity ◽  
Daily Data ◽  
Health Organization

Abstract Background: Countries are trying several policy options for decreasing the incidence and burden of the COVID-19. One of these strategies is a lockdown, complete closure, to reduce the risk of distributing disease via social interactions. This study aimed to analyze the effect of a three-week lockdown on the mortality and morbidity of the COVID-19 in Iran. Methods: Official daily data on COVID-19 incidence and death reported on the COVID-19 by the World Health Organization (WHO) were extracted from September 1, 2020, to January 14, 2021. Data were analyzed using interrupted time series analysis via STATA 14 software. Results: Lockdown resulted in a significant reduction in the daily death from Covid-19 in the short-term (β=-139, P<0.01) and in the long-term (β=-12, P<0.01). Moreover, lockdown in the short-term insignificantly (β=-21.58, P=0.969), and in the long-term significantly (β=-317.31, P<0.01) reduced the Covid-19 daily incidence. Discussion: The results showed that the lockdown has a significant effect on incidence and death numbers. Therefore, it could be a suitable short-term strategy for controlling the COVID-19 outbreak. On the other hand, its negative effects on households and businesses should be considered.

scholarly journals Antibiotic Consumption in the Latvian Teaching Hospital 2000-2008

2009 ◽  
Vol 63 (4-5) ◽  
pp. 253-256
Author(s):  
Elīna Dimiņa ◽  
Mārtiņš Akermanis ◽  
Uga Dumpis
Keyword(s):  
Teaching Hospital ◽  
Enzyme Inhibitor ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Antibiotic Consumption ◽  
Resistance Selection ◽  
Defined Daily Doses ◽  
Multiresistant Bacteria ◽  
Bed Days ◽  
The Impact

Antibiotic Consumption in the Latvian Teaching Hospital 2000-2008 Antibiotics are one of the most commonly used drugs in hospital care and significantly contribute to healthcare costs. Recently, there has been significant interest raised on the environmental impact of antibiotic use, in particular on how it effects resistance selection pressure. Rapid global spread of multiresistant bacteria requires improved understanding on how changes in antibiotic use affect resistance selection. We present a unique study on antibiotic consumption and its trends over an eight-year period. Data were obtained from the pharmaceutical database system. The study period extended from January 2000 through December 2008. Antibiotic use was expressed as a rate — defined daily doses (DDD) per 100 patient days (DDD/100) in a quarter year. The total amount of antibiotics used for systemic treatment at the beginning of the period (first quarter of 2000) was 38.7 DDD per 100 bed days and increased to 72.6 DDD per 100 bed days (r = 0.81) by the 4th quarter of 2008. Despite variability during the study period, a significant trend was observed with an average increase of 0.97 (95% CI: 1.2; 3.2) per quarter. Penicillin was the most common antibiotic group used at the hospital in the study period and demonstrated the greatest increase in consumption (r = 0.92). The consumption rates of fluoroquinolones were high and also showed a significant increase (r = 0.76). We observed a significant increase of antibiotic consumption in our hospital during the study period, which lacked a clear explanation. This increase was mostly due to increased use of amoxicillinum/enzyme inhibitor and ceftriaxone. Analysis of consumption should be continued to assess the impact of educational interventions.

SUMBER-SUMBER RESILIENSI PADA REMAJA AKHIR YANG MENGALAMI KEKERASAN DARI ORANGTUA PADA MASA KANAK-KANAK

Psibernetika ◽  
2018 ◽  
Vol 11 (1) ◽  
Author(s):  
Devina Calista ◽  
Garvin Garvin
Keyword(s):  
Late Adolescents ◽  
Long Term Effects ◽  
Short Term ◽  
Parental Affection ◽  
Resilience Factors ◽  
Childhood Violence ◽  
Past Experiences ◽  
The Impact ◽  
Depth Interviews

<p><em>Child abuse by parents is common in households. The impact of violence on children will bring short-term effects and long-term effects that can be attributed to their various emotional, behavioral and social problems in the future; especially in late adolescence that will enter adulthood. Resilience factors increase the likelihood that adolescents who are victims of childhood violence recover from their past experiences</em><em>,</em><em> become more powerful individuals and have a better life. The purpose of this study was to determine the source of resilience in late adolescents who experienced violence from parents in their childhood. This research uses qualitative research methods with in-depth interviews as a method of data collection. The result shows that the three research participants have the aspects of "I Have", "I Am", and "I Can"; a participant has "I Can" aspects as a source of resilience, and one other subject has no source of resilience. The study concluded that parental affection and acceptance of the past experience have role to the three sources of resilience (I Have, I Am, and I Can)</em></p><p><em> </em></p><p><strong><em>Keyword : </em></strong><em>Resilience, adolescence, violence, parents</em></p>

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