Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-28T17:08:59.017Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of California’s mandate for antimicrobial stewardship programs on rates of methicillin-resistant Staphylococcus aureus and Clostridioides difficile infection in acute-care hospitals

Published online by Cambridge University Press:  01 October 2020

Alessandra B. Garcia Reeves Open the ORCID record for Alessandra B. Garcia Reeves [Opens in a new window] ,
Sally C. Stearns ,
Justin G. Trogdon ,
James W. Lewis ,
David J. Weber  and
Morris Weinberger
Alessandra B. Garcia Reeves*
Affiliation:
Research on Healthcare Value, Equity and the Lifespan (REHVEAL), Research Triangle Institute (RTI International), Durham, North Carolina
Sally C. Stearns
Affiliation:
Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
Justin G. Trogdon
Affiliation:
Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
James W. Lewis
Affiliation:
Division of Public Health, Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, North Carolina
David J. Weber
Affiliation:
Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
Morris Weinberger
Affiliation:
Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
*
Author for correspondence: Alessandra B. Garcia Reeves, E-mail: alessandrabg@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To estimate the impact of California’s antimicrobial stewardship program (ASP) mandate on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infection (CDI) rates in acute-care hospitals.

Population:

Centers for Medicare and Medicaid Services (CMS)–certified acute-care hospitals in the United States.

Data Sources:

2013–2017 data from the CMS Hospital Compare, Provider of Service File and Medicare Cost Reports.

Methods:

Difference-in-difference model with hospital fixed effects to compare California with all other states before and after the ASP mandate. We considered were standardized infection ratios (SIRs) for MRSA and CDI as the outcomes. We analyzed the following time-variant covariates: medical school affiliation, bed count, quality accreditation, number of changes in ownership, compliance with CMS requirements, % intensive care unit beds, average length of stay, patient safety index, and 30-day readmission rate.

Results:

In 2013, California hospitals had an average MRSA SIR of 0.79 versus 0.94 in other states, and an average CDI SIR of 1.01 versus 0.77 in other states. California hospitals had increases (P < .05) of 23%, 30%, and 20% in their MRSA SIRs in 2015, 2016, and 2017, respectively. California hospitals were associated with a 20% (P < .001) decrease in the CDI SIR only in 2017.

Conclusions:

The mandate was associated with a decrease in CDI SIR and an increase in MRSA SIR.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 3 , March 2021 , pp. 298 - 304
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Antibiotic use is rapidly increasing in developing countries. The Economist website. https://www.economist.com/graphic-detail/2018/04/02/antibiotic-use-is-rapidly-increasing-in-developing-countries. Published 2018. Accessed September 8, 2020.Google Scholar
Antibiotic resistance threats in the United States. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/threat-report-2013/index.html. Published 2013. Accessed September 8, 2020.Google Scholar
Dar, OA, Hasan, R, Schlundt, J, et al. Exploring the evidence base for national and regional policy interventions to combat resistance. Lancet 2016;387:285–295.CrossRefGoogle ScholarPubMed
Hadler, JL, Yousey-hindes, K, Kudish, K, Kennedy, ED, Sacco, V. Impact of requiring influenza vaccination for children in licensed child care or preschool programs — Connecticut, 2012–13 influenza season. Morb Mortal Wkly Rep 2014;63:181–185.Google ScholarPubMed
Overt, M, Scale, A. When the drugs don’t work: the rise of antibiotic resistance. The Economist May 21, 2016.Google Scholar
Kesselheim, AS, Outterson, K. Fighting antibiotic resistance: marrying new financial incentives to meeting public health goals. Health Aff 2010;29:1689–1696.CrossRefGoogle ScholarPubMed
Srinivasan, A, Fishman, N. Antimicrobial stewardship 2012: science driving practice. Infect Control Hosp Epidemiol 2012;33:319–321.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Checklist for core elements of hospital antibiotic stewardship programs. https://www.cdc.gov/antibiotic-use/healthcare/implementation/checklist.html. Published 2014. Accessed March 7, 2019.Google Scholar
Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/core-elements/hospital-summary.html. Published 2014. Accessed September 9, 2020.Google Scholar
Hospital Compare: about the data: infections. Centers for Medicare and Medicaid Services website. https://www.medicare.gov/hospitalcompare/Data/Healthcare-Associated-Infections.html. Published 2019. Accessed August 2, 2018.Google Scholar
Mijović, B, Dubravac-Tanasković, M, Račić, M, Bojanić, J, Stanić, S, Lazarević, DB. Outcomes of intrahospital antimicrobial stewardship programs related to prevention of Clostridium difficile infection outbreaks. Med Glas 2018;15:122–131.Google ScholarPubMed
O’Leary, EN, Van Santen, KL, Webb, AK, Pollock, DA, Edwards, JR, Srinivasan, A. Uptake of antibiotic stewardship programs in US acute care hospitals: findings from the 2015 National Healthcare Safety Network annual hospital survey. Clin Infect Dis 2017;65:1748–1750.CrossRefGoogle ScholarPubMed
Ge, IY, Fevrier, HB, Conell, C, et al. Reducing risk of Clostridium difficile infection and overall use of antibiotic in the outpatient treatment of urinary tract infection. Ther Adv Urol 2018. doi: 10.1177/1756287218783871.CrossRefGoogle ScholarPubMed
Dantes, R, Mu, Y, Hicks, LA, et al. Association between outpatient antibiotic prescribing practices and community-associated Clostridium difficile infection. Open Forum Infect Dis 2015. doi: 10.1093/ofid/ofv113.CrossRefGoogle ScholarPubMed
Balsells, E, Filipescu, T, Kyaw, MH, Wiuff, C. Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations. J Glob Health 2016;6(2):1–18.CrossRefGoogle Scholar
Karanika, S, Paudel, S, Grigoras, C, Kalbasi, A, Mylonakis, E. Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial. Antimicrob Agents Chemother 2016;60:4840–4852.CrossRefGoogle ScholarPubMed
Trivedi, KK, Rosenberg, J. The state of antimicrobial stewardship programs in California. Infect Control Hosp Epidemiol 2013;34:379–384.CrossRefGoogle ScholarPubMed
Halpin, HA, Milstein, A, Shortell, SM, Vanneman, M, Rosenberg, J. Mandatory public reporting of hospital-acquired infection rates: A report from California. Health Aff 2011;30:723–729.CrossRefGoogle ScholarPubMed
Antibiotic stewardship programs vary in US hospitals: CDC survey explores how hospital size, location may influence details. The Pew Charitable Trusts website. https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2016/10/antibiotic-stewardship-programs-vary-in-us-hospitals. Published 2017. Accessed March 7, 2019.Google Scholar
SB 1311, Hospitals: Antimicrobial Stewardship. Sacramento, CA: State of California Press; 2014.Google Scholar
Rizzo, K, Kealey, M, Epson, E. Antimicrobial stewardship practices reported by California hospitals following new legislative requirements: analysis of National Healthcare Safety Network annual survey data, 2014–2015. Infect Control Hosp Epidemiol 2017:2015–2017.Google Scholar
Antibiotic resistance patient safety atlas: antibiotic resistance HAI data. Centers for Disease Control and Prevention website. https://gis.cdc.gov/grasp/PSA/MapView.html. Published 2016. Accessed September 7, 2020.Google Scholar
Shah, N, Joshi, A, Ganguly, B. Impact of antibiotic stewardship program on prescribing pattern of antimicrobials in patients of medical intensive care unit. J Clin Diagnostic Res 2017;7:FC11–FC15.Google Scholar
Turner, RB, Valcarlos, E, Loeffler, AM, Gilbert, M, Chan, D. Impact of an antimicrobial stewardship program on antibiotic use at a nonfreestanding childrens hospital. J Pediatr Infect Dis Soc 2017;6:36–40.Google Scholar
Pate, PG, Storey, DF, Baum, DL. Implementation of an antimicrobial stewardship program at a 60-bed long-term acute-care hospital. Infect Control Hosp Epidemiol 2012;33:3–6.CrossRefGoogle Scholar
Storey, DF, Pate, PG, Nguyen, ATT, Chang, F. Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital. Antimicrob Resist Infect Control 2012;32:1–8.Google Scholar
Taggart, LR, Leung, E, Muller, MP, Matukas, LM, Daneman, N. Differential outcome of an antimicrobial stewardship audit and feedback program in two intensive care units : a controlled interrupted time series study. Infect Dis (Auckl) 2015. doi: 10.1186/s12879-015-1223-2.Google ScholarPubMed
Talpaert, MJ, Rao, GG, Cooper, BS, Wade, P. Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother 2011;66:2168–2174.CrossRefGoogle ScholarPubMed
Vernaz, N, Sax, H, Pittet, D, Bonnabry, P, Schrenzel, J, Harbarth, S. Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile . J Antimicrob Chemother 2008;62:601–607.CrossRefGoogle ScholarPubMed
Christensen, A, Barr, V, Martin, D, et al. Diagnostic stewardship of C. difficile testing: a quasi-experimental antimicrobial stewardship study. Infect Control Hosp Epidemiol 2019;40:269–275.CrossRefGoogle Scholar
Fridkin, S, Baggs, J, Fagan, R. Vital signs: improving antibiotic use among hospitalized patients. Morb Mortal Wkly Rep 2014;63:194–200.Google ScholarPubMed
Tamma, PD, Avdic, E, Li, DX, Dzintars, K, Cosgrove, SE. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med 2017;177:1308–1315.CrossRefGoogle ScholarPubMed
Conlon-Bingham, GM, Aldeyab, M, Scott, M, et al. Effects of antibiotic cycling policy on incidence of healthcare-associated MRSA and Clostridioides difficile infection in secondary healthcare settings. Emerg Infect Dis 2019;25:52–62.CrossRefGoogle ScholarPubMed
Zhang, D, Cui, K, Wang, T, et al. Trends in and correlations between antibiotic consumption and resistance of Staphylococcus aureus at a tertiary hospital in China before and after introduction of an antimicrobial stewardship programme. Epidemiol Infect 2019;147. doi: 10.1017/S0950268818003059.Google Scholar
Paving the Path Forward: 2015 Rebaseline. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/2015rebaseline/index.html. Published 2015. Accessed September 9, 2020.Google Scholar
Reagan, J, Herzig, C, Pogorzelska-Maziarz, M, Dick, A, Stone, P, Srinath, JD. State law mandates for reporting of healthcare-associated Clostridium difficile infections in hospitals. Infect Control Hosp Epidemiol 2015;36:350–352.CrossRefGoogle ScholarPubMed
Pollack, LA, Santen, KL Van, Weiner, LM, Dudeck, MA, Edwards, JR, Srinivasan, A. Antibiotic stewardship programs in US acute care hospitals: findings from the 2014 National Healthcare Safety Network annual hospital survey. Clin Infect Dis 2016;63:443–449.CrossRefGoogle ScholarPubMed
The Joint Commission. New antimicrobial stewardship standard. Jt Comm Perspect 2016;36(7).Google Scholar
General Assembly of the State of Missouri. 98th General Assembly 2016. Senate Bill No. 579. Modifies Provisions Relating to Infection Reporting of Health Care Facilities and Telehealth Services. Senate of the State of Missouri; 2016.Google Scholar
Stenehjem, E, Hersh, AL, Buckel, WR, et al. Stewardship in Community Hospitals-Optimizing Outcomes and Resources (SCORE): a cluster-randomized controlled trial investigating the impact of antibiotic stewardship in 15 small, community hospitals. Open Forum Infect Dis 2016;3 suppl 1. doi: 10.1093/ofid/ofw194.CrossRefGoogle Scholar