Giuseppe
Emeritus
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 - Chicago Journals
Original Article
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
Klaus Kaier, Dipl‐Vw; Christian Hagist, PhD; Uwe Frank, MD;Andreas Conrad, MD; Elisabeth Meyer, MD
From the Department of Environmental Health Sciences, University Medical Center Freiburg (K.K., U.F., A.C.), the Research Center for Generational Contracts, Freiburg University (K.K., C.H.), Freiburg, and the Institute of Hygiene and Environmental Medicine, Charit??Medical University Berlin, Berlin (E.M.), Germany.
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<0.001 ). The multivariate analysis (Rsq=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=0.023 ), third‐generation cephalosporins (p=0.05 ), fluoroquinolones (p=0.01 ), and lincosamides (p=.05 ). The multivariate analysis (Rsq=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.
Received July 30, 2008; accepted November 20, 2008; electronically published February 23, 2009.
Address reprint requests to Klaus Kaier, Department of Environmental Health Sciences, University Medical Center Freiburg, Breisacher Stra?e 115b, Freiburg D‐79106, Germany (klaus.kaier@uniklinik‐freiburg.de).
-
<cite cite="http://www.journals.uchicago.edu/doi/abs/10.1086/596605">Chicago Journals - Infection Control and Hospital Epidemiology</cite>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
Klaus Kaier, Dipl‐Vw; Christian Hagist, PhD; Uwe Frank, MD;Andreas Conrad, MD; Elisabeth Meyer, MD
From the Department of Environmental Health Sciences, University Medical Center Freiburg (K.K., U.F., A.C.), the Research Center for Generational Contracts, Freiburg University (K.K., C.H.), Freiburg, and the Institute of Hygiene and Environmental Medicine, Charit??Medical University Berlin, Berlin (E.M.), Germany.
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<0.001 ). The multivariate analysis (Rsq=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=0.023 ), third‐generation cephalosporins (p=0.05 ), fluoroquinolones (p=0.01 ), and lincosamides (p=.05 ). The multivariate analysis (Rsq=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.
Received July 30, 2008; accepted November 20, 2008; electronically published February 23, 2009.
Address reprint requests to Klaus Kaier, Department of Environmental Health Sciences, University Medical Center Freiburg, Breisacher Stra?e 115b, Freiburg D‐79106, Germany (klaus.kaier@uniklinik‐freiburg.de).
-