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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

Published online by Cambridge University Press:  20 December 2019

Alessandra B. Garcia Reeves
Affiliation:
Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina Social Policy, Health & Economics Research, Research Triangle Institute, Durham, North Carolina
James W. Lewis
Affiliation:
Division of Public Health, Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, 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
Sally C. Stearns
Affiliation:
Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, 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
Corresponding

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.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved

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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
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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
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