Faculty Opinions recommendation of Impact of Discontinuing Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: An Interrupted Time Series Analysis.

2019 ◽  
Author(s):  
Pranavi Sreeramoju
Keyword(s):  
Staphylococcus Aureus ◽  
Time Series ◽  
Time Series Analysis ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Interrupted Time Series ◽  
Vancomycin Resistant Enterococcus ◽  
Interrupted Time Series Analysis ◽  
Methicillin Resistant ◽  
Contact Precautions ◽  
Vancomycin Resistant

scholarly journals Antimicrobial Stewardship in a Hematological Malignancy Unit: Carbapenem Reduction and Decreased Vancomycin-Resistant Enterococcus Infection

2019 ◽  
Vol 71 (4) ◽  
pp. 960-967 ◽  
Author(s):  
Brandon J Webb ◽  
Jacob Majers ◽  
Regan Healy ◽  
Peter Bjorn Jones ◽  
Allison M Butler ◽  
...  
Keyword(s):  
Time Series ◽  
Febrile Neutropenia ◽  
Time Series Analysis ◽  
Hematological Malignancy ◽  
Interrupted Time Series ◽  
Vancomycin Resistant Enterococcus ◽  
Clinical Prediction ◽  
Interrupted Time Series Analysis ◽  
Vancomycin Resistant ◽  
Antibiotic Cycling

Abstract Background Antibiotic stewardship is challenging in hematological malignancy patients. Methods We performed a quasiexperimental implementation study of 2 antimicrobial stewardship interventions in a hematological malignancy unit: monthly antibiotic cycling for febrile neutropenia that included cefepime (± metronidazole) and piperacillin-tazobactam and a clinical prediction rule to guide anti-vancomycin-resistant Enterococcus faecium (VRE) therapy. We used interrupted time-series analysis to compare antibiotic use and logistic regression in order to adjust observed unit-level changes in resistant infections by background community rates. Results A total of 2434 admissions spanning 3 years pre- and 2 years postimplementation were included. Unadjusted carbapenem and daptomycin use decreased significantly. In interrupted time-series analysis, carbapenem use decreased by −230 days of therapy (DOT)/1000 patient-days (95% confidence interval [CI], −290 to −180; P < .001). Both VRE colonization (odds ratio [OR], 0.64; 95% CI, 0.51 to 0.81; P < .001) and infection (OR, 0.41; 95% CI, 0.2 to 0.9; P = .02) decreased after implementation. This shift may have had a greater effect on daptomycin prescribing (−160 DOT/1000 patient-days; 95% CI, −200 to −120; P < .001) than did the VRE clinical prediction score (−30 DOT/1000 patient-days; 95% CI, −50 to 0; P = .08). Also, 46.2% of Pseudomonas aeruginosa isolates were carbapenem-resistant preimplementation compared with 25.0% postimplementation (P = .32). Unit-level changes in methicillin-resistant Staphylococcus aureus and extended-spectrum beta lactamase (ESBL) incidence were explained by background community-level trends, while changes in AmpC ESBL and VRE appeared to be independent. The program was not associated with increased mortality. Conclusions An antibiotic cycling-based strategy for febrile neutropenia effectively reduced carbapenem use, which may have resulted in decreased VRE colonization and infection and perhaps, in turn, decreased daptomycin prescribing.

scholarly journals Using Interrupted Time Series Analysis To Assess Associations of Fluoroquinolone Formulary Changes with Susceptibility of Gram-Negative Pathogens and Isolation Rates of Methicillin-Resistant Staphylococcus aureus

2006 ◽  
Vol 50 (6) ◽  
pp. 2106-2112 ◽  
Author(s):  
John A. Bosso ◽  
Patrick D. Mauldin
Keyword(s):  
Staphylococcus Aureus ◽  
Time Series ◽  
Time Series Analysis ◽  
Bacterial Resistance ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Isolation Rate ◽  
Gram Negative ◽  
Methicillin Resistant ◽  
Series Analysis

ABSTRACT The use of fluoroquinolones has been linked to increasing bacterial resistance and infection and/or colonization with already resistant pathogens both as a risk factor and based on volume of use. Changes in individual fluoroquinolones used in an institution may also be related to these clinical problems. Interrupted time series analysis, which allows for assessment of the associations of an outcome attributable to a specific event in time, was used to study the effect of changes in our hospital's fluoroquinolone formulary on fluoroquinolone susceptibility rates in select gram-negative pathogens and the methicillin-resistant Staphylococcus aureus (MRSA) isolation rate. Susceptibility rates to ciprofloxacin were considered for the period of 1993 through 2004, while the MRSA isolation rate was assessed from 1995 through 2004. Levofloxacin was added to the formulary in 1999, and gatifloxacin was substituted for levofloxacin in 2001. Statistically significant changes in the already declining rates of susceptibility of Pseudomonas aeruginosa (P, 0.042) and Escherichia coli (P, 0.004) to ciprofloxacin and in the already rising MRSA isolation rate (P, 0.001) were associated with the addition of levofloxacin to the formulary. Substitution of gatifloxacin for levofloxacin on the formulary was associated with reversals in the downward trend in E. coli susceptibility to ciprofloxacin and the upward trend in MRSA isolation rate. No associations were detected on susceptibility of Klebsiella pneumoniae or Proteus mirabilis to ciprofloxacin. These findings suggest that potential changes in susceptibility to fluoroquinolones and isolation of MRSA may vary by both drug and organism.

scholarly journals Resource Burden Associated with Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: The Patient Access Managers' Perspective

2012 ◽  
Vol 33 (8) ◽  
pp. 849-852 ◽  
Author(s):  
Erica S. Shenoy ◽  
Rochelle P. Walensky ◽  
Hang Lee ◽  
Benjamin Orcutt ◽  
David C. Hooper
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Vancomycin Resistant Enterococcus ◽  
Patient Access ◽  
Methicillin Resistant ◽  
Contact Precautions ◽  
Factors Influencing ◽  
History Of ◽  
Vancomycin Resistant ◽  
The Impact

We surveyed patient access managers on the impact of contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) on time to bed assignment, and we investigated the factors influencing infection control policies allowing for discontinuation of CP. The majority of respondents reported an increase in time to bed assignment for patients with a history of MRSA and/or VRE infection or colonization.

scholarly journals Has the Emergence of Community-Associated Methicillin-Resistant Staphylococcus aureus Increased Trimethoprim-Sulfamethoxazole Use and Resistance?: a 10-Year Time Series Analysis

2012 ◽  
Vol 56 (11) ◽  
pp. 5655-5660 ◽  
Author(s):  
Jameson B. Wood ◽  
Donald B. Smith ◽  
Errol H. Baker ◽  
Stephen M. Brecher ◽  
Kalpana Gupta
Keyword(s):  
Staphylococcus Aureus ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Rate Of Change ◽  
Interrupted Time Series Analysis ◽  
Methicillin Resistant ◽  
Content Type ◽  
Series Analysis ◽  
The Relationship

ABSTRACTThere are an increasing number of indications for trimethoprim-sulfamethoxazole use, including skin and soft tissue infections due to community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA). Assessing the relationship between rates of use and antibiotic resistance is important for maintaining the expected efficacy of this drug for guideline-recommended conditions. Using interrupted time series analysis, we aimed to determine whether the 2005 emergence of CA-MRSA and recommendations of trimethoprim-sulfamethoxazole as the preferred therapy were associated with changes in trimethoprim-sulfamethoxazole use and susceptibility rates. The data from all VA Boston Health Care System facilities, including 118,863 inpatient admissions, 6,272,661 outpatient clinic visits, and 10,138 isolates were collected over a 10-year period. There was a significant (P= 0.02) increase in trimethoprim-sulfamethoxazole prescriptions in the post-CA-MRSA period (1,605/year) compared to the pre-CA-MRSA period (1,538/year). Although the overall susceptibility ofEscherichia coliandProteusspp. to trimethoprim-sulfamethoxazole decreased over the study period, the rate of change in the pre- versus the post-CA-MRSA period was not significantly different. The changes in susceptibility rates ofS. aureusto trimethoprim-sulfamethoxazole and to methicillin were also not significantly different. The CA-MRSA period is associated with a significant increase in use of trimethoprim-sulfamethoxazole but not with significant changes in the rates of susceptibilities among clinical isolates. There is also no evidence for selection of organisms with increased resistance to other antimicrobials in relation to increased trimethoprim-sulfamethoxazole use.

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