Association between statewide adoption of the CDC’s Core Elements of Hospital Antimicrobial Stewardship Programs and rates of methicillin-resistant Staphylococcus aureus bacteremia and Clostridioides difficile infection in the United States

Abstract

Objective:To measure the association between statewide adoption of the Centers for Disease Control and Prevention’s (CDC’s) Core Elements for Hospital Antimicrobial Stewardship Programs (Core Elements) and hospital-associated methicillin-resistant Staphylococcus aureus bacteremia (MRSA) and Clostridioides difficile infection (CDI) rates in the United States. We hypothesized that states with a higher percentage of reported compliance with the Core Elements have significantly lower MRSA and CDI rates.Participants:All US states.Design:Observational longitudinal study.Methods:We used 2014–2016 data from Hospital Compare, Provider of Service files, Medicare cost reports, and the CDC’s Patient Safety Atlas website. Outcomes were MRSA standardized infection ratio (SIR) and CDI SIR. The key explanatory variable was the percentage of hospitals that meet the Core Elements in each state. We estimated state and time fixed-effects models with time-variant controls, and we weighted our analyses for the number of hospitals in the state.Results:The percentage of hospitals reporting compliance with the Core Elements between 2014 and 2016 increased in all states. A 1% increase in reported ASP compliance was associated with a 0.3% decrease (P < .01) in CDIs in 2016 relative to 2014. We did not find an association for MRSA infections.Conclusions:Increasing documentation of the Core Elements may be associated with decreases in the CDI SIR. We did not find evidence of such an association for the MRSA SIR, probably due to the short length of the study and variety of stewardship strategies that ASPs may encompass.

Clostridioides difficilePrevalence in the United States: National Inpatient Sample, 2016 to 2018

“…Although prevention of C difficile has generally focused on interventions targeting symptomatic patients in healthcare settings, such as isolation and environmental cleaning, increasing data suggest that symptomatic healthcare cases are not the only source for transmission [ 7 ]. Thus, interventions focused on symptomatic patients, although important and effective, will need augmentation from additional measures [ 8 ]. The variation in the proportion of cases that are community acquired, as well as differences in the likelihood that patients are symptomatic, suggest that interventions in the community and long-term care settings are both likely needed to aid transmission reduction [ 7 , 9 , 10 ].…”

Core Elements for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals

“…According to a 2018 survey, 85% of acute care hospitals in the United States had seven core elements, an increase from 41% in 2014 [ 99 ]. A study in the United States revealed that a 1% increase in the proportion of hospitals performing core elements was associated with a 0.3% lower incidence of hospital-acquired CDI [ 131 ]. In this study, the performance of the core elements and MRSA showed no significant correlation [ 131 ].…”

“…A study in the United States revealed that a 1% increase in the proportion of hospitals performing core elements was associated with a 0.3% lower incidence of hospital-acquired CDI [ 131 ]. In this study, the performance of the core elements and MRSA showed no significant correlation [ 131 ]. The advantages of meeting the core elements include reducing the use of antimicrobials for acute upper respiratory tract infections in outpatients and improving the appropriateness of use and cost-effectiveness [ 132 ].…”

Pattern of Antibiotic Use among Hospitalized Patients at a Level One Multidisciplinary Care Hospital

“…Treatment failure increases medical costs and hospital stays, and Clostridioides difficile infection resulting from the misuse of antibiotics. Irrational prescribing can be result of a lack of drug understanding, unethical drug promotion, a high patient load, inefficient laboratory facilities, medication availability, ineffective law enforcement, and failure to assure compliance with recommendations [2,3].…”