Identification of antibiotic consumption targets for the management of Clostridioides difficile infection in hospitals- a threshold logistic modelling approach.

Autor:	Aldeyab MA; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK., Bond SE; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.; Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK., Gould I; Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, UK., Lee-Milner J; Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK., Spencer-Jones JJ; Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK., Guleri A; Infection/Clinical Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK., Sadeq A; Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, UAE., Jirjees F; Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, UAE., Lattyak WJ; Statistical Consulting Department, Scientific Computing Associates Corp, River Forest, IL, USA.
Jazyk:	angličtina
Zdroj:	Expert review of anti-infective therapy [Expert Rev Anti Infect Ther] 2023 Jul-Dec; Vol. 21 (10), pp. 1125-1134. Date of Electronic Publication: 2023 Oct 27.
DOI:	10.1080/14787210.2023.2263642
Abstrakt:	Background: This study aims to demonstrate the utility of a threshold logistic approach to identifying thresholds for specific antibiotic use associated with Clostridioides difficile infection (CDI) in an English teaching hospital. Methods: A combined approach of nonlinear modeling and logistic regression, named threshold logistic, was used to identify thresholds and risk scores in hospital-level antibiotic use associated with hospital-onset, healthcare-associated (HOHA) CDI cases. Results: Using a threshold logistic regression approach, an incidence greater than 0.2645 cases/1000 occupied bed-days (OBD; 85th percentile) was determined as the cutoff rate to define a critical (high) incidence rate of HOHA CDI. Fluoroquinolones and piperacillin-tazobactam were found to have thresholds at 84.8 and 54 defined daily doses (DDD)/1000 OBD, respectively. Analysis of data allowed calculating risk scores for HOHA CDI incidence rates exceeding the 85th percentile, i.e. entering critical incidence level. The threshold-logistic model also facilitated performing 'what-if scenarios' on future values of fluoroquinolones and piperacillin-tazobactam use to understand how HOHA CDI incidence rates may be affected. Conclusion: Using threshold logistic analysis, critical incidence levels and antibiotic use targets to control HOHA CDI were determined. Threshold logistic models can be used to inform and enhance the effective design and implementation of antimicrobial stewardship programs.
Databáze:	MEDLINE
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