Effects of Antibiotic Cycling Policy on Incidence of Healthcare-Associated MRSA and Clostridioides difficile Infection in Secondary Healthcare Settings

• Main Authors: Geraldine Mary Conlon-Bingham, Mamoon Aldeyab, Michael Scott, Mary Patricia Kearney, David Farren, Fiona Gilmore, James McElnay
• Format: Article
• Language: English
• Published: Centers for Disease Control and Prevention 2019-01-01
• Series: Emerging Infectious Diseases
• Subjects: Clostridioides difficile; Clostridium difficile; methicillin-resistant Staphylococcus aureus; extended-spectrum β-lactamase; MRSA; CDI
• Online Access: https://wwwnc.cdc.gov/eid/article/25/1/18-0111_article
• ISSN: 1080-6040; 1080-6059

This quasi-experimental study investigated the effect of an antibiotic cycling policy based on time-series analysis of epidemiologic data, which identified antimicrobial drugs and time periods for restriction. Cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin were undertaken over a 2-year period in the intervention hospital. We used segmented regression analysis to compare the effect on the incidence of healthcare-associated Clostridioides difficile infection (HA-CDI), healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA), and new extended-spectrum β-lactamase (ESBL) isolates and on changes in resistance patterns of the HA-MRSA and ESBL organisms between the intervention and control hospitals. HA-CDI incidence did not change. HA-MRSA incidence increased significantly in the intervention hospital. The resistance of new ESBL isolates to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly in the intervention hospital; however, resistance to piperacillin/tazobactam increased after a return to the standard policy. The results question the value of antibiotic cycling to antibiotic stewardship.