Forecasting carbapenem resistance from antimicrobial consumption surveillance: Lessons learnt from an OXA-48-producing Klebsiella pneumoniae outbreak in a West London renal unit
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
This study aimed to forecast the incidence rate of carbapenem resistance and to assess the impact of an antimicrobial stewardship intervention using routine antimicrobial consumption surveillance data. Following an outbreak of OXA-48-producing Klebsiella pneumoniae (January 2008–April 2010) in a renal cohort in London, a forecasting ARIMA model was derived using meropenem consumption data [defined daily dose per 100 occupied bed-days (DDD/100 OBD)] from 2005–2014 as a predictor of the incidence rate of OXA-48-producing organisms (number of new cases/year/100,000 OBD). Interrupted times series assessed the impact of meropenem consumption restriction as part of the outbreak control. Meropenem consumption at lag −1 year (the preceding year), highly correlated with the incidence of OXA-48-producing organisms (r = 0.71; P = 0.005), was included as a predictor within the forecasting model. The number of cases/100,000 OBD for 2014–2015 was estimated to be 4.96 (95% CI 2.53–7.39). Analysis of meropenem consumption pre- and post-intervention demonstrated an increase of 7.12 DDD/100 OBD/year (95% CI 2.97–11.27; P < 0.001) in the 4 years preceding the intervention, but a decrease thereafter. The change in slope was −9.11 DDD/100 OBD/year (95% CI −13.82 to −4.39). Analysis of alternative antimicrobials showed a significant increase in amikacin consumption post-intervention from 0.54 to 3.41 DDD/100 OBD/year (slope +0.72, 95% CI 0.29–1.15; P = 0.01). Total antimicrobials significantly decreased from 176.21 to 126.24 DDD/100 OBD/year (P = 0.05). Surveillance of routinely collected antimicrobial consumption data may provide a key warning indicator to anticipate increased incidence of carbapenem-resistant organisms. Further validation using real-time data is needed.
Date Issued
2015-04-23
Date Acceptance
2015-03-12
Citation
International Journal of Antimicrobial Agents, 2015, 46 (2), pp.150-156
ISSN
1872-7913
Publisher
Elsevier
Start Page
150
End Page
156
Journal / Book Title
International Journal of Antimicrobial Agents
Volume
46
Issue
2
Copyright Statement
© 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Sponsor
Medical Research Council (MRC)
National Institute for Health Research
National Institute for Health Research
National Institute of Health Research Imperial Biomedical Research Centre
Grant Number
G0800777
RDA02 79560
HPRU-2012-10047
WMNF_P46472
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Microbiology
Pharmacology & Pharmacy
Time series analyses
Carbapenemase
Antimicrobial resistance
Healthcare-associated infection
Antimicrobial stewardship
INTERRUPTED TIME-SERIES
CLOSTRIDIUM-DIFFICILE
INTERVENTION
STRATEGIES
POLICY
Anti-Bacterial Agents
Disease Outbreaks
Drug Utilization
Epidemiological Monitoring
Forecasting
Hospitals
Humans
Incidence
Klebsiella Infections
Klebsiella pneumoniae
London
Models, Statistical
Retrospective Studies
Thienamycins
beta-Lactam Resistance
beta-Lactamases
1108 Medical Microbiology
1115 Pharmacology And Pharmaceutical Sciences
Publication Status
Published