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Two Time-Series Analyses of the Impact of Antibiotic Consumption and Alcohol-Based Hand Disinfection on the Incidences of Nosocomial Methicillin-Resistant Staphylococcus aureus Infection and Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Klaus Kaier ,
Christian Hagist ,
Uwe Frank ,
Andreas Conrad  and
Elisabeth Meyer
Klaus Kaier*
Affiliation:
Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg Research Center for Generational Contracts, Freiburg University, Freiburg
Christian Hagist
Affiliation:
Research Center for Generational Contracts, Freiburg University, Freiburg
Uwe Frank
Affiliation:
Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg
Andreas Conrad
Affiliation:
Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg
Elisabeth Meyer
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité–Medical University Berlin, Berlin, Germany
*
Department of Environmental Health Sciences, University Medical Center Freiburg, Breisacher Straße 115b, Freiburg D-79106, Germany ([email protected])
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Abstract

Objective.

To determine the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection and Clostridium difficile infection (CDI).

Methods.

Two multivariate time-series analyses were performed that used as dependent variables the monthly incidences of nosocomial MRSA infection and CDI at the Freiburg University Medical Center during the period January 2003 through October 2007. The volume of alcohol-based hand rub solution used per month was quantified in liters per 1,000 patient-days. Antibiotic consumption was calculated in terms of the number of defined daily doses per 1,000 patient-days per month.

Results.

The use of alcohol-based hand rub was found to have a significant impact on the incidence of nosocomial MRSA infection (P<.001). The multivariate analysis (R2 = 0.66) showed that a higher volume of use of alcohol-based hand rub was associated with a lower incidence of nosocomial MRSA infection. Conversely, a higher level of consumption of selected antimicrobial agents was associated with a higher incidence of nosocomial MRSA infection. This analysis showed this relationship was the same for the use of second-generation cephalosporins (P = .023), third-generation cephalosporins (P = .05), fluoroquinolones (P = .01), and lincosamides (P = .05). The multivariate analysis (R2 = 0.55) showed that a higher level of consumption of third-generation cephalosporins (P = .008), fluoroquinolones (P = .084), and/or macrolides (P = .007) was associated with a higher incidence of CDI. A correlation with use of alcohol-based hand rub was not detected.

Conclusion.

In 2 multivariate time-series analyses, we were able to show the impact of hand hygiene and antibiotic use on the incidence of nosocomial MRSA infection, but we found no association between hand hygiene and incidence of CDI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 4 , April 2009 , pp. 346 - 353
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.Chaberny, IF, Ziesing, S, Mattner, F, et al.The burden of MRSA in four German university hospitals. Int J Hyg Environ Health 2005;208:447–453.CrossRefGoogle ScholarPubMed
2.Cosgrove, SE, Qi, Y, Kaye, KS, et al.The impact of mefhicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.Google Scholar
3.Harbarth, S. Control of endemic methicillin-resistant Staphylococcus aureus—recent advances and future challenges. Clin Microbiol Infect 2006;12:1154–62.CrossRefGoogle ScholarPubMed
4.Aldeyab, MA, Monnet, DL, Lopez-Lozano, JM, et al.Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: a time-series analysis. J Antimicrob Chemother 2008;62:593–600.Google Scholar
5.Vernaz, N, Sax, H, Pittet, D, et al.Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile. J Antimicrob Chemother 2008;62:601–607.Google Scholar
6.Lopez-Lozano, JM, Monnet, DL, Yague, A, et al.Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis. Int J Antimicrob Agents 2000;14:21–31.Google Scholar
7.Monnet, DL, MacKenzie, FM, Lopez-Lozano, JM, et al.Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000. Emerg Infect Dis 2004;10:1432–1441.CrossRefGoogle ScholarPubMed
8.Stone, SP, Cooper, BS, Kibbler, CC, et al.The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection. Lancet Infect Dis 2007;7:282–288.Google Scholar
9.Greene, WH. Econometric analysis. Upper Saddle River, NJ: Prentice Hall; 1997.Google Scholar
10.Harrington, G, Watson, K, Bailey, M, et al.Reduction in hospitalwide incidence of infection or colonization with methicillin-resistant Staphylococcus aureus with use of antimicrobial hand-hygiene gel and statistical process control charts. Infect Control Hosp Epidemiol 2007;28:837–844.Google Scholar
11.Johnson, PD, Martin, R, Burrell, LJ, et al.Efficacy of an alcohol/chlor-hexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005;183:509–514.CrossRefGoogle Scholar
12.Lai, KK, Fontecchio, S, Melvin, Z, Baker, SP. Impact of alcohol-based, waterless hand antiseptic on the incidence of infection and colonization with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2006;27:1018–1024.Google Scholar
13.Pittet, D, Hugonnet, S, Harbarth, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
14.Mahamat, A, MacKenzie, FM, Brooker, K, Monnet, DL, Daures, JP, Gould, IM. Impact of infection control interventions and antibiotic use on hospital MRSA: a multivariate interrupted time-series analysis. Int J Antimicrob Agents 2007;30:169–176.Google Scholar
15.MacDougall, C, Powell, JP, Johnson, CK, Edmond, MB, Polk, RE. Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals. Clin Infect Dis 2005;41:435–440.Google Scholar
16.Dziekan, G, Hahn, A, Thune, K, et al.Methicillin-resistant Staphylococcus aureus in a teaching hospital: investigation of nosocomial transmission using a matched case-control study. J Hosp Infect 2000;46:263–270.CrossRefGoogle Scholar
17.Crowcroft, NS, Ronveaux, O, Monnet, DL, et al.Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals. Infect Control Hosp Epidemiol 1999;20:31–36.CrossRefGoogle ScholarPubMed
18.Charbonneau, P, Parienti, JJ, Thibon, P, et al.Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: a quasi experimental study. Clin Infect Dis 2006;42:778–784.Google Scholar
19.Madaras-Kelly, KJ, Remington, RE, Lewis, PG, et al.Evaluation of an intervention designed to decrease the rate of nosocomial methicillin-resistant Staphylococcus aureus infection by encouraging decreased fluoroquinolone use. Infect Control Hosp Epidemiol 2006;27:155–169.Google Scholar
20.Meyer, E, Schwab, F, Gastmeier, P, Jonas, D, Rueden, H, Daschner, FD. Methicillin-resistant Staphylococcus aureus in German intensive care units during 2000-2003: data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units). Infect Control Hosp Epidemiol 2006;27:146–154.Google Scholar
21.Muller, AA, Mauny, F, Bertin, M, et al.Relationship between spread of methicillin-resistant Staphylococcus aureus and antimicrobial use in a French university hospital. Clin Infect Dis 2003;36:971–978.Google Scholar
22.Bisognano, C, Vaudaux, P, Rohner, P, et al.Induction of fibronectin-binding proteins and increased adhesion of quinolone-resistant Staphylococcus aureus by subinhibitory levels of ciprofloxacin. Antimicrob Agents Chemother 2000;44:1428.CrossRefGoogle ScholarPubMed
23.Baxter, R, Ray, GT, Fireman, BH. Case-control study of antibiotic use and subsequent Clostridium difficile–associated diarrhea in hospitalized patients. Infect Control Hosp Epidemiol 2008;29:44–50.Google Scholar
24.Deshpande, A, Pant, C, Jain, A, et al.Do fluoroquinolones predispose patients to Clostridium difficile associated disease? A review of the evidence. Curr Med Res Opin 2008;24:329–333.Google Scholar
25.Pépin, J, Saheb, N, Coulombe, MA, et al.Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile–associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254–1260.CrossRefGoogle ScholarPubMed
26.Eckmanns, T, Bessert, J, Behnke, M, et al.Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27:931–934.Google Scholar
27.Kritsotakis, EI, Christidou, A, Roumbelaki, M, Tselentis, Y, Gikas, A. The dynamic relationship between antibiotic use and the incidence of vancomycin-resistant Enterococcus: time-series modelling of 7-year surveillance data in a tertiary-care hospital. Clin Microbiol Infect 2008;14:747–754.Google Scholar