Impact of an intervention to control Clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis
Strategies to reduce rates of Clostridium difficile infection (CDI) generally recommend isolation or cohorting of active cases and the reduced use of cephalosporin and quinolone antibiotics. Data supporting these recommendations come predominantly from the setting of epidemic disease caused by ribot...
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| creator | Price, J. Cheek, E. Lippett, S. Cubbon, M. Gerding, D.N. Sambol, S.P. Citron, D.M. Llewelyn, M. |
| description | Strategies to reduce rates of Clostridium difficile infection (CDI) generally recommend isolation or cohorting of active cases and the reduced use of cephalosporin and quinolone antibiotics. Data supporting these recommendations come predominantly from the setting of epidemic disease caused by ribotype 027 strains. We introduced an initiative involving a restrictive antibiotic policy and a CDI-cohort ward at an acute, 820-bed teaching hospital where ribotype 027 strains account for only one quarter of all CDI cases. Antibiotic use and monthly CDI cases in the 12 months before and the 15 months after the initiative were compared using an interrupted time series analysis and segmented regression analysis. The initiative resulted in a reduced level of cephalosporin and quinolone use (22.0% and 38.7%, respectively, both p |
| doi_str_mv | 10.1111/j.1469-0691.2009.03077.x |
| format | Article |
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Data supporting these recommendations come predominantly from the setting of epidemic disease caused by ribotype 027 strains. We introduced an initiative involving a restrictive antibiotic policy and a CDI-cohort ward at an acute, 820-bed teaching hospital where ribotype 027 strains account for only one quarter of all CDI cases. Antibiotic use and monthly CDI cases in the 12 months before and the 15 months after the initiative were compared using an interrupted time series analysis and segmented regression analysis. The initiative resulted in a reduced level of cephalosporin and quinolone use (22.0% and 38.7%, respectively, both p <0.001) and changes in the trends of antibiotic use such that cephalosporin use decreased by an additional 62.1 defined daily doses (DDD) per month (p <0.001) and antipseudomonal penicillin use increased by 20.7 DDD per month (p = 0.011). There were no significant changes in doxycycline or carbapenem use. Although the number of CDI cases each month was falling before the intervention, there was a significant increase in the rate of reduction after the intervention from 3% to 8% per month (0.92, 95% CI 0.86–0.99, p = 0.03). During the study period, there was no change in the proportion of cases having their onset in the community, nor in the proportion of ribotype 027 cases. CDI cohorting and restriction of cephalosporin and quinolone use are effective in reducing CDI cases in a setting where ribotype 027 is endemic.</description><identifier>ISSN: 1198-743X</identifier><identifier>EISSN: 1469-0691</identifier><identifier>DOI: 10.1111/j.1469-0691.2009.03077.x</identifier><identifier>PMID: 19832710</identifier><language>eng</language><publisher>Oxford, UK: Elsevier Ltd</publisher><subject>Anti-Bacterial Agents - therapeutic use ; Antibacterial agents ; Antibiotic policy ; Antibiotics ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Bacterial diseases ; Bacterial diseases of the digestive system and abdomen ; Biological and medical sciences ; Carbapenems ; Carbapenems - therapeutic use ; Cephalosporins ; Cephalosporins - therapeutic use ; Clostridium difficile ; Clostridium difficile - isolation & purification ; clostridium difficile, Infection control ; Clostridium Infections - epidemiology ; Clostridium Infections - prevention & control ; Community-Acquired Infections - prevention & control ; Cross Infection - prevention & control ; Data processing ; Doxycycline ; Doxycycline - therapeutic use ; Drug Utilization - trends ; Epidemics ; Gastroenterology. Liver. Pancreas. Abdomen ; Health Services Research ; Hospitals ; Human bacterial diseases ; Humans ; Infection ; Infection control ; Infection Control - methods ; Infectious diseases ; Medical sciences ; Organizational Policy ; Other diseases. Semiology ; Penicillin ; Pharmacology. Drug treatments ; Prevalence ; Quinolones ; Quinolones - therapeutic use ; Regression analysis ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Time series</subject><ispartof>Clinical microbiology and infection, 2010-08, Vol.16 (8), p.1297-1302</ispartof><rights>2010 European Society of Clinical Infectious Diseases</rights><rights>2010 The Authors. 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Data supporting these recommendations come predominantly from the setting of epidemic disease caused by ribotype 027 strains. We introduced an initiative involving a restrictive antibiotic policy and a CDI-cohort ward at an acute, 820-bed teaching hospital where ribotype 027 strains account for only one quarter of all CDI cases. Antibiotic use and monthly CDI cases in the 12 months before and the 15 months after the initiative were compared using an interrupted time series analysis and segmented regression analysis. The initiative resulted in a reduced level of cephalosporin and quinolone use (22.0% and 38.7%, respectively, both p <0.001) and changes in the trends of antibiotic use such that cephalosporin use decreased by an additional 62.1 defined daily doses (DDD) per month (p <0.001) and antipseudomonal penicillin use increased by 20.7 DDD per month (p = 0.011). There were no significant changes in doxycycline or carbapenem use. Although the number of CDI cases each month was falling before the intervention, there was a significant increase in the rate of reduction after the intervention from 3% to 8% per month (0.92, 95% CI 0.86–0.99, p = 0.03). During the study period, there was no change in the proportion of cases having their onset in the community, nor in the proportion of ribotype 027 cases. CDI cohorting and restriction of cephalosporin and quinolone use are effective in reducing CDI cases in a setting where ribotype 027 is endemic.</description><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibacterial agents</subject><subject>Antibiotic policy</subject><subject>Antibiotics</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Bacterial diseases</subject><subject>Bacterial diseases of the digestive system and abdomen</subject><subject>Biological and medical sciences</subject><subject>Carbapenems</subject><subject>Carbapenems - therapeutic use</subject><subject>Cephalosporins</subject><subject>Cephalosporins - therapeutic use</subject><subject>Clostridium difficile</subject><subject>Clostridium difficile - isolation & purification</subject><subject>clostridium difficile, Infection control</subject><subject>Clostridium Infections - epidemiology</subject><subject>Clostridium Infections - prevention & control</subject><subject>Community-Acquired Infections - prevention & control</subject><subject>Cross Infection - prevention & control</subject><subject>Data processing</subject><subject>Doxycycline</subject><subject>Doxycycline - therapeutic use</subject><subject>Drug Utilization - trends</subject><subject>Epidemics</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Health Services Research</subject><subject>Hospitals</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infection</subject><subject>Infection control</subject><subject>Infection Control - methods</subject><subject>Infectious diseases</subject><subject>Medical sciences</subject><subject>Organizational Policy</subject><subject>Other diseases. Semiology</subject><subject>Penicillin</subject><subject>Pharmacology. Drug treatments</subject><subject>Prevalence</subject><subject>Quinolones</subject><subject>Quinolones - therapeutic use</subject><subject>Regression analysis</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. 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Antiinfectious agents. Antiparasitic agents</topic><topic>Bacterial diseases</topic><topic>Bacterial diseases of the digestive system and abdomen</topic><topic>Biological and medical sciences</topic><topic>Carbapenems</topic><topic>Carbapenems - therapeutic use</topic><topic>Cephalosporins</topic><topic>Cephalosporins - therapeutic use</topic><topic>Clostridium difficile</topic><topic>Clostridium difficile - isolation & purification</topic><topic>clostridium difficile, Infection control</topic><topic>Clostridium Infections - epidemiology</topic><topic>Clostridium Infections - prevention & control</topic><topic>Community-Acquired Infections - prevention & control</topic><topic>Cross Infection - prevention & control</topic><topic>Data processing</topic><topic>Doxycycline</topic><topic>Doxycycline - therapeutic use</topic><topic>Drug Utilization - trends</topic><topic>Epidemics</topic><topic>Gastroenterology. Liver. Pancreas. 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Anus</topic><topic>Time series</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Price, J.</creatorcontrib><creatorcontrib>Cheek, E.</creatorcontrib><creatorcontrib>Lippett, S.</creatorcontrib><creatorcontrib>Cubbon, M.</creatorcontrib><creatorcontrib>Gerding, D.N.</creatorcontrib><creatorcontrib>Sambol, S.P.</creatorcontrib><creatorcontrib>Citron, D.M.</creatorcontrib><creatorcontrib>Llewelyn, M.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical microbiology and infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Price, J.</au><au>Cheek, E.</au><au>Lippett, S.</au><au>Cubbon, M.</au><au>Gerding, D.N.</au><au>Sambol, S.P.</au><au>Citron, D.M.</au><au>Llewelyn, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of an intervention to control Clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis</atitle><jtitle>Clinical microbiology and infection</jtitle><addtitle>Clin Microbiol Infect</addtitle><date>2010-08</date><risdate>2010</risdate><volume>16</volume><issue>8</issue><spage>1297</spage><epage>1302</epage><pages>1297-1302</pages><issn>1198-743X</issn><eissn>1469-0691</eissn><abstract>Strategies to reduce rates of Clostridium difficile infection (CDI) generally recommend isolation or cohorting of active cases and the reduced use of cephalosporin and quinolone antibiotics. Data supporting these recommendations come predominantly from the setting of epidemic disease caused by ribotype 027 strains. We introduced an initiative involving a restrictive antibiotic policy and a CDI-cohort ward at an acute, 820-bed teaching hospital where ribotype 027 strains account for only one quarter of all CDI cases. Antibiotic use and monthly CDI cases in the 12 months before and the 15 months after the initiative were compared using an interrupted time series analysis and segmented regression analysis. The initiative resulted in a reduced level of cephalosporin and quinolone use (22.0% and 38.7%, respectively, both p <0.001) and changes in the trends of antibiotic use such that cephalosporin use decreased by an additional 62.1 defined daily doses (DDD) per month (p <0.001) and antipseudomonal penicillin use increased by 20.7 DDD per month (p = 0.011). There were no significant changes in doxycycline or carbapenem use. Although the number of CDI cases each month was falling before the intervention, there was a significant increase in the rate of reduction after the intervention from 3% to 8% per month (0.92, 95% CI 0.86–0.99, p = 0.03). During the study period, there was no change in the proportion of cases having their onset in the community, nor in the proportion of ribotype 027 cases. CDI cohorting and restriction of cephalosporin and quinolone use are effective in reducing CDI cases in a setting where ribotype 027 is endemic.</abstract><cop>Oxford, UK</cop><pub>Elsevier Ltd</pub><pmid>19832710</pmid><doi>10.1111/j.1469-0691.2009.03077.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical microbiology and infection, 2010-08, Vol.16 (8), p.1297-1302 |
| issn | 1198-743X 1469-0691 |
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| source | MEDLINE; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Anti-Bacterial Agents - therapeutic use Antibacterial agents Antibiotic policy Antibiotics Antibiotics. Antiinfectious agents. Antiparasitic agents Bacterial diseases Bacterial diseases of the digestive system and abdomen Biological and medical sciences Carbapenems Carbapenems - therapeutic use Cephalosporins Cephalosporins - therapeutic use Clostridium difficile Clostridium difficile - isolation & purification clostridium difficile, Infection control Clostridium Infections - epidemiology Clostridium Infections - prevention & control Community-Acquired Infections - prevention & control Cross Infection - prevention & control Data processing Doxycycline Doxycycline - therapeutic use Drug Utilization - trends Epidemics Gastroenterology. Liver. Pancreas. Abdomen Health Services Research Hospitals Human bacterial diseases Humans Infection Infection control Infection Control - methods Infectious diseases Medical sciences Organizational Policy Other diseases. Semiology Penicillin Pharmacology. Drug treatments Prevalence Quinolones Quinolones - therapeutic use Regression analysis Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Time series |
| title | Impact of an intervention to control Clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis |
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