Pnina Shitrit

Impact of Quinolone Restriction on Resistance Patterns of Escherichia coli Isolated from Urine by Culture in a Community Setting

BACKGROUND Decreased antimicrobial susceptibility after increased antibiotic use is a known phenomenon. Restoration of susceptibility once antimicrobial use is decreased is not self-evident. Our objective was to evaluate, in a community setting, the impact of quinolone restriction on the antimicrobial resistance of E. coli urine isolates. METHODS We conducted a retrospective, quasi-experimental ecological study to assess the proportion of quinolone-susceptible E. coli urine isolates in the periods before, during, and after a nationwide restriction on ciprofloxacin use was implemented. We used an interrupted time interval analysis for outcome evaluation. RESULTS We found a significant decline in quinolone consumption, measured as defined daily doses (DDDs) per month, between the preintervention and intervention periods (point estimate, -1827.3 DDDs per month; 95% confidence interval [CI], -2248.8 to -1405.9 DDDs per month; p < .001). This decline resulted in a significant decrease in E. coli nonsusceptibility to quinolones, from a mean of 12% in the preintervention period to a mean of 9% in the intervention period (odds ratio, 1.35; p = .014). The improved susceptibility pattern reversed immediately when quinolone consumption rose. Moreover, a highly significant inverse relationship was found between the level of quinolone use (regardless of intervention period) and the susceptibility of E. coli urine isolates to quinolone (odds ratio, 1.70; 95% CI, 1.26-2.28). During the months of highest quinolone use (8321 DDDs per month), the proportion of nonsusceptibility was 14%, whereas during the months of lowest quinolone use (4027 DDDs per month), the proportion of nonsusceptibility was 9%. An average decrease in resistance of 1.16% was observed for each decrease of 1000 DDDs. CONCLUSION Reducing quinolone consumption can lead to an immediate increase in the susceptibility of E. coli urine isolates to quinolones.

Active Surveillance for Methicillin‐Resistant Staphylococcus aureus (MRSA) Decreases the Incidence of MRSA Bacteremia

OBJECTIVES To evaluate the influence of performance of active surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) on the incidence of nosocomial MRSA bacteremia in an endemic hospital. DESIGN Before-after trial. SETTING A 700-bed hospital. PATIENTS All patients admitted to the hospital who were at high risk for MRSA bacteremia. INTERVENTION Performance of surveillance cultures for detection of MRSA were recommended for all patients at high risk, and contact isolation was implemented for patients with positive results of culture. Each MRSA-positive patient received one course of eradication treatment. We compared the total number of surveillance cultures, the percentage of surveillance cultures with positive results, and the number of MRSA bacteremia cases before the intervention (from January 2002 through February 2003) after the start of the intervention (from July 2003 through October 2004). RESULTS The number of surveillance cultures performed increased from a mean of 272.57 cultures/month before the intervention to 865.83 cultures/month after the intervention. The percentage of surveillance cultures with positive results increased from 3.13% before to 5.22% after the intervention (P < .001). The mean number of MRSA bacteremia cases per month decreased from 3.6 cases before the intervention to 1.8 cases after the intervention (P < 0.001). CONCLUSIONS Active surveillance culture is important for identifying hidden reservoirs of MRSA. Contact isolation can prevent new colonization and infection and lead to a significant reduction of morbidity and healthcare costs.

Extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage upon hospital admission: prevalence and risk factors

The aim of this study was to assess the value of surveillance cultures in identifying extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL) carriers upon admission to hospital, and to identify risk factors for carriage. This prospective cross-sectional study included all hospital admissions over one week. Of 525 patients screened, 56 were positive for ESBLs. Half were only identified through screening. Four independent risk factors were identified: nursing home residency, hospitalization in the previous year, prior antibiotic treatment and prior ESBL carriage. Over 50% of the screened patients had at least one risk factor. By screening this targeted population, 87.5% of positive patients would have been identified.

Hospital-Wide Methicillin-Resistant Staphylococcus aureus Control Program: A 5-Year Follow-up

We investigated the influence of different interventions (active surveillance, contact isolation, monitoring, and rapid diagnostic testing) on the number of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia cases. An interrupted time-series analysis was used. MRSA bacteremia cases were reduced by 70% when all interventions were in place. We proved monitoring to be an essential component.

The effect of empiric antibiotic therapy on mortality in debilitated patients with dementia

The purpose of this investigation was to assess the effect of empirical antibiotic treatment on 30-day mortality among debilitated inpatients with dementia and Gram-negative bacteremia. A retrospective cohort study in the years 2005–2007 was undertaken. Data were collected through patient chart review. The association between individual variables and 30-day mortality was assessed through univariate analysis. Variables significantly associated with mortality (p < 0.05) were entered into a logistic regression analysis. Adjusted odds ratios (ORs) for mortality with 95% confidence intervals (CIs) are shown. Subgroup analysis of patients with and without decubitus ulcers was performed. In our cohort of 378 patients with dementia and Gram-negative bacteremia, the 30-day mortality was 39% overall and 61% in the subgroup of patients with decubitus ulcers. Inappropriate empirical therapy was associated with higher mortality, although this effect was not statistically significant (OR 1.41, 95% CI 0.86–2.29). Inappropriate empirical therapy did not affect mortality in the subgroup of patients with decubitus ulcers (OR 0.37, 95% CI 0.11–1.28). Other factors found to independently affect mortality included age, co-morbidities, source of infection, sepsis severity, and hospital-acquired infection. Appropriate empirical antibiotic therapy for patients with dementia and severe bacterial infection did not have a clear advantage, especially in the sickest group of patients with decubitus ulcers.

Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) Transmission

Introduction Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. Methods We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. Results An average of 20,000 patients were screened yearly. The cost of prevention was

Intervention to Reduce Ventilator‐Associated Pneumonia in Individuals on Long‐Term Ventilation by Introducing a Customized Bundle

208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was

Measurement of HIV RNA in patients infected by subtype C by assays optimized for subtype B results in an underestimation of the viral load.

14,500, and the net cost attributable to nosocomial bacteremia was

Comparative performance of the Amplicor HIV-1 Monitor Assay versus NucliSens EasyQ in HIV subtype C-infected patients.

9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of

The Impact of a national intervention on hospital-acquired bloodstream infection rates in Israeli intensive care units

199,600. Conclusions A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country.