Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-10-31T11:21:35.153Z Has data issue: false hasContentIssue false

Association between statewide adoption of the CDC’s Core Elements of Hospital Antimicrobial Stewardship Programs and rates of methicillin-resistant Staphylococcus aureus bacteremia and Clostridioides difficile infection in the United States

Published online by Cambridge University Press:  20 December 2019

Alessandra B. Garcia Reeves*
Affiliation:
Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina Social Policy, Health & Economics Research, Research Triangle Institute, Durham, North Carolina
James W. Lewis
Affiliation:
Division of Public Health, Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, North Carolina
Justin G. Trogdon
Affiliation:
Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
Sally C. Stearns
Affiliation:
Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
Morris Weinberger
Affiliation:
Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
*
Author for correspondence: Alessandra B. Garcia Reeves, E-mail: alessabg@live.unc.edu or alessandrabg@gmail.com

Abstract

Objective:

To measure the association between statewide adoption of the Centers for Disease Control and Prevention’s (CDC’s) Core Elements for Hospital Antimicrobial Stewardship Programs (Core Elements) and hospital-associated methicillin-resistant Staphylococcus aureus bacteremia (MRSA) and Clostridioides difficile infection (CDI) rates in the United States. We hypothesized that states with a higher percentage of reported compliance with the Core Elements have significantly lower MRSA and CDI rates.

Participants:

All US states.

Design:

Observational longitudinal study.

Methods:

We used 2014–2016 data from Hospital Compare, Provider of Service files, Medicare cost reports, and the CDC’s Patient Safety Atlas website. Outcomes were MRSA standardized infection ratio (SIR) and CDI SIR. The key explanatory variable was the percentage of hospitals that meet the Core Elements in each state. We estimated state and time fixed-effects models with time-variant controls, and we weighted our analyses for the number of hospitals in the state.

Results:

The percentage of hospitals reporting compliance with the Core Elements between 2014 and 2016 increased in all states. A 1% increase in reported ASP compliance was associated with a 0.3% decrease (P < .01) in CDIs in 2016 relative to 2014. We did not find an association for MRSA infections.

Conclusions:

Increasing documentation of the Core Elements may be associated with decreases in the CDI SIR. We did not find evidence of such an association for the MRSA SIR, probably due to the short length of the study and variety of stewardship strategies that ASPs may encompass.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Antimicrobial resistance action package. Global Health Security Agenda website. https://ghsagenda.org/home/action-packages/antimicrobial-resistance/.Google Scholar
Biggest threats and data. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/threat-report-2013/index.html. Published 2013. Accessed December 2, 2019.Google Scholar
Dellit, TH, Owens, RC, Mcgowan, JE, et al.Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.CrossRefGoogle Scholar
Fridkin, S, Baggs, J, Fagan, R.Vital signs: improving antibiotic use among hospitalized patients. Morb Mortal Wkly Rep 2014;63:194200.Google ScholarPubMed
Levin, PD, Idrees, S, Sprung, CL, et al.Antimicrobial use in the ICU: indications and accuracy-an observational trial. J Hosp Med 2012;7:672678.CrossRefGoogle Scholar
Alshammari, TM, Larrat, EP, Morrill, HJ, Caffrey, AR, Quilliam, BJ, LaPlante, KL. Risk of hepatotoxicity associated with fluoroquinolones: a national case-control safety study. Am J Heal Pharm 2014;71:3743.CrossRefGoogle ScholarPubMed
Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/core-elements/hospital.html. Published 2014. Accessed December 2, 2019.Google Scholar
Karanika, S, Paudel, S, Grigoras, C, Kalbasi, A, Mylonakis, E.Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs. Antimicrob Agents Chemother 2016;60:48404852.CrossRefGoogle ScholarPubMed
Morrill, HJ, Caffrey, AR, Gaitanis, MM, Laplante, KL.Impact of a prospective audit and feedback antimicrobial stewardship program at a Veterans’ Affairs medical center: a six-point assessment. PLoS One 2016;11(3):120.CrossRefGoogle Scholar
Khdour, MR, Hallak, HO, Aldeyab, MA, et al.Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: a prospective audit and feedback study. Br J Clin Pharmacol 2018;84:708715.CrossRefGoogle ScholarPubMed
DiazGranados, CA. Prospective audit for antimicrobial stewardship in intensive care: impact on resistance and clinical outcomes. Am J Infect Control 2012;40:526529.CrossRefGoogle ScholarPubMed
Schuts, EC, Hulscher, MEJL, Mouton, JW, et al.Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis 2016;16:847856.CrossRefGoogle ScholarPubMed
Kelly, AA, Jones, MM, Echevarria, KL, et al.A report of the efforts of the veterans health administration national antimicrobial stewardship initiative. Infect Control Hosp Epidemiol 2017;38:513520.CrossRefGoogle ScholarPubMed
Mijović, B, Dubravac-Tanasković, M, Račić, M, Bojanić, J, Stanić, S, Lazarević, DB.Outcomes of intrahospital antimicrobial stewardship programs related to prevention of clostridium difficile infection outbreaks. Med Glas 2018;15:122131.Google ScholarPubMed
Antimicrobial stewardship toolkit. The Joint Commission website. https://www.jcrinc.com/antimicrobial-stewardship-toolkit/. Published 2013. Accessed December 2, 2019.Google Scholar
Antibiotic resistance patient safety atlas: antibiotic resistance HAI data. Centers for Disease Control and Prevention website. https://gis.cdc.gov/grasp/PSA/MapView.html. Published 2016. Accessed December 2, 2019.Google Scholar
Fast facts on US hospitals. American Hospital Association website. https://www.aha.org/statistics/fast-facts-us-hospitals. Published 2019. Accessed December 2, 2019.Google Scholar
Hospital Compare. About the data: infections. Centers for Medicare and Medicaid Services website. https://www.medicare.gov/hospitalcompare/Data/Healthcare-Associated-Infections.html. Published 2019. Accessed August 2, 2018.Google Scholar
Pollack, LA, Santen, KL Van, Weiner, LM, Dudeck, MA, Edwards, JR, Srinivasan, A.Antibiotic stewardship programs in US acute-care hospitals: findings from the 2014 National Healthcare Safety Network annual hospital survey. Clin Infect Dis 2016;63:443449.CrossRefGoogle ScholarPubMed
Antibiotic stewardship programs vary in US hospitals: CDC survey explores how hospital size, location may influence details. The Pew Charitable Trusts website. https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2016/10/antibiotic-stewardship-programs-vary-in-us-hospitals. Published 2017. Accessed March 7, 2019.Google Scholar
FACT SHEET: Obama administration releases national action plan to combat antibiotic-resistant bacteria. The White House website. https://www.whitehouse.gov/the-press-office/2015/03/27/fact-sheet-obama-administration-releases-national-action-plan-combat-ant. Published 2015. Accessed December 2, 2019.Google Scholar
Barlam, TF, Cosgrove, SE, Abbo, LM, et al.Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:11971202.CrossRefGoogle Scholar
New antimicrobial stewardship standard. The Joint Commission website. https://www.jointcommission.org/assets/1/6/New_Antimicrobial_Stewardship_Standard.pdf. Published 2016. Accessed December 2, 2019.Google Scholar
Pogorzelska-Maziarz, M, Herzig, CTA, Larson, EL, Furuya, EY, Perencevich, EN, Stone, PW.Implementation of antimicrobial stewardship policies in US hospitals: findings from a national survey. Infect Control Hosp Epidemiol 2015;36(3):261264.CrossRefGoogle Scholar
O’Leary, EN, Van Santen, KL, Webb, AK, Pollock, DA, Edwards, JR, Srinivasan, A.Uptake of antibiotic stewardship programs in US acute-care hospitals: findings from the 2015 National Healthcare Safety Network annual hospital survey. Clin Infect Dis 2017;65(10):17481750.CrossRefGoogle ScholarPubMed
Logan, A, Williamson, J, Reinke, E, Jarrett, S, Boger, M, Davidson, L.Establishing an antimicrobial stewardship collaborative across a large, diverse healthcare system. Jt Comm J Qual Patient Saf 2019;45:591599.Google Scholar
Talpaert, MJ, Rao, GG, Cooper, BS, Wade, P.Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother 2011;66:21682174.CrossRefGoogle ScholarPubMed
Christensen, A, Barr, V, Martin, D, et al.Diagnostic stewardship of C. difficile testing: a quasi-experimental antimicrobial stewardship study. Infect Control Hosp Epidemiol 2019;40:269275.CrossRefGoogle ScholarPubMed
Dantes, R, Mu, Y, Hicks, LA, et al.Association between outpatient antibiotic prescribing practices and community-associated Clostridium difficile infection. Open Forum Infect Dis 2015;2(3):ofv113. doi:10.1093/ofid/ofv113.CrossRefGoogle ScholarPubMed
Sarma, JB, Marshall, B, Cleeve, V, Tate, D, Oswald, T, Woolfrey, S.Effects of fluoroquinolone restriction (from 2007 to 2012) on Clostridium difficile infections: interrupted time-series analysis. J Hosp Infect 2015;91:7480.CrossRefGoogle ScholarPubMed
Elligsen, M, Walker, SA, Pinto, R, et al.Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis. Infect Control Hosp Epidemiol 2012;33:354361.CrossRefGoogle ScholarPubMed
Cohen, SH, Gerding, DN, Johnson, S, et al.Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431455.CrossRefGoogle Scholar
Boel, J, Andreasen, V, Jarløv, JO, et al.Impact of antibiotic restriction on resistance levels of Escherichia coli: a controlled interrupted time series study of a hospital-wide antibiotic stewardship programme. J Antimicrob Chemother 2016;71:20472051.CrossRefGoogle ScholarPubMed
Lawes, T, Lopez-Lozano, JM, Nebot, CA, et al.Effect of a national 4C antibiotic stewardship intervention on the clinical and molecular epidemiology of Clostridium difficile infections in a region of Scotland: a non-linear time-series analysis. Lancet Infect Dis 2017;17:194206.CrossRefGoogle Scholar
Davey, P, Marwick, CA, Scott, CL, et al.Interventions to improve antibiotic prescribing practices for hospital inpatients (review). Cochrane Database Syst Rev 2017;2:CD003543. doi:10.1002/14651858.cd003543.pub4.Google Scholar
Lawes, T, López-Lozano, JM, Nebot, C, et al.Turning the tide or riding the waves? Impacts of antibiotic stewardship and infection control on MRSA strain dynamics in a Scottish region over 16 years: non-linear time series analysis. BMJ Open 2015;5:e006596. doi:10.1136/bmjopen-2014-006596.CrossRefGoogle ScholarPubMed
Kim, YC, Kim, MH, Song, JE, et al.Trend of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in an institution with a high rate of MRSA after the reinforcement of antibiotic stewardship and hand hygiene. Am J Infect Control 2013;41(5):e39e43.CrossRefGoogle Scholar