Abstract
This quasi-experimental study investigated the effect of an antibiotic cycling policy based on time-series analysis of epidemiologic data, which identified antimicrobial drugs and time periods for restriction. Cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin were undertaken over a 2-year period in the intervention hospital. We used segmented regression analysis to compare the effect on the incidence of healthcare-associated Clostridioides difficile infection (HA-CDI), healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA), and new extended-spectrum β-lactamase (ESBL) isolates and on changes in resistance patterns of the HA-MRSA and ESBL organisms between the intervention and control hospitals. HA-CDI incidence did not change. HA-MRSA incidence increased significantly in the intervention hospital. The resistance of new ESBL isolates to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly in the intervention hospital; however, resistance to piperacillin/tazobactam increased after a return to the standard policy. The results question the value of antibiotic cycling to antibiotic stewardship.
Highlights
Restrictive antimicrobial prescribing guidelines have successfully reduced the incidence of Clostridioides difficile infection (CDI; formerly Clostridium difficile) and methicillin-resistant Staphylococcus aureus (MRSA) [1,2,3,4,5,6]
We aimed to evaluate the effect of an antibiotic cycling policy, derived using time-series analysis of retrospective epidemiologic data, on the incidence of healthcare-associated MRSA (HA-MRSA) and healthcare-associated CDI (HA-CDI)
Based on the antimicrobial drugs that were significantly associated with HA-CDI and HA-MRSA, together with the time lag between observing a change in the antimicrobial drug use and a corresponding change in HA-MRSA or HA-CDI incidence, we developed an antibiotic cycling policy and implemented it in Area Hospital (AAH) over a 2-year period (October 13–September 15) (Figure 2)
Summary
Restrictive antimicrobial prescribing guidelines have successfully reduced the incidence of Clostridioides difficile infection (CDI; formerly Clostridium difficile) and methicillin-resistant Staphylococcus aureus (MRSA) [1,2,3,4,5,6]. These guidelines have been suggested to create an environment of antimicrobial homogeneity that may enhance the development and spread of antimicrobial resistance [7,8]. Antibiotic cycling has been proposed as an effective strategy to increase antimicrobial heterogeneity and Author affiliations: Queen’s University Belfast, Belfast, Northern Ireland, UK A secondary aim was to evaluate the effect of this policy on the incidence of infections caused by extended-spectrum β-lactamase (ESBL)–producing organisms
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