Monitoring antimicrobial resistance (AMR) using CUSUM control charts.
We evaluated the use of the Cumulative Summation (CUSUM) control chart methodology for detection of an excessive increase in antimicrobial-resistant (AMR) bacteria acquisition. We used administrative, clinical and bacteriological data from all 157,570 patients hospitalized for at least 48 h from January 1, 2010 to December 31, 2015 in a 654-bed university teaching hospital in Paris, France. Monthly computed CUSUM were evaluated for the detection of out-of-control situations, defined as incidence rates of acquired AMR bacterial colonization exceeding acceptable thresholds at the hospital and ward levels (based on six selected wards) for AMR bacteria overall and Extended-spectrum beta-lactamases Enterobacteriaceae (ESBL-E) and Methicillin-resistant Staphylococcus aureus (MRSA), specifically. During the study period, 1,403 samples of acquired AMR bacteria were identified including 1,129 ESBL-E and 151 MRSA. The incidence rate of acquired AMR bacteria was stable at the hospital and the wards level. When based on AMR bacteria overall, CUSUM alarms were triggered at the hospital level and at the ward level in four units. For ESBL-E, CUSUM tests generated alarms at the hospital level and for the same four wards, and for MRSA, CUSUM tests detected out-of-control situations in all the wards. The CUSUM approach appears complementary with hospital infection control strategies currently in practice and appears of interest in common practice as a simple tool for AMR surveillance.
Postgraduate School of Public Health, Siena, Italy. Lorenzo.righi@gmail.com.|Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. Lorenzo.righi@gmail.com.|Quality of Care Service, University Hospitals of Geneva, Chemin Thury 3, 1206, Geneva, Switzerland. Lorenzo.righi@gmail.com.
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http://orcid.org/0000-0001-9915-1332
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Righi
Infection Control Unit, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|APHP-Lariboisière Hospital, Hopitaux Universitaires Saint Louis-Lariboisière-Fernand Widal, Bacteriology, Paris, France.
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Amarsy
Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
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Picat
Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
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Thuillier
APHP-Lariboisière Hospital, Hopitaux Universitaires Saint Louis-Lariboisière-Fernand Widal, Bacteriology, Paris, France.|Inserm UMR 1137, IAME, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
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Cambau
Infection Control Unit, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|APHP-Lariboisière Hospital, Hopitaux Universitaires Saint Louis-Lariboisière-Fernand Widal, Bacteriology, Paris, France.
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Raskine
Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|ECSTRA Team, Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-1153, Epidemiology and Biostatistics Sorbonne Paris Cite Research Center (CRESS), Paris, France.
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Chevret
Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.|ECSTRA Team, Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-1153, Epidemiology and Biostatistics Sorbonne Paris Cite Research Center (CRESS), Paris, France.
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Flicoteaux
D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D062665:Epidemiological Monitoring; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D012189:Retrospective Studies