title: Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus.
abstract: A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL)-producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P<0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P=0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens.
authors.affiliation: Department of Microbiology, Hairmyres Hospital, East Kilbride, Lanarkshire G75 8RG, UK. stephanie.dancer@lanarkshire.scot.nhs.uk
authors.forename: S J
authors.initials: SJ
authors.lastname: Dancer
authors.forename: P
authors.initials: P
authors.lastname: Kirkpatrick
authors.forename: D S
authors.initials: DS
authors.lastname: Corcoran
authors.forename: F
authors.initials: F
authors.lastname: Christison
authors.forename: D
authors.initials: D
authors.lastname: Farmer
authors.forename: C
authors.initials: C
authors.lastname: Robertson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D002443:Ceftriaxone / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008875:Middle Aged; D016134:Organizational Policy; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002443:Ceftriaxone