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      STROBE-AMS: recommendations to optimise reporting of epidemiological studies on antimicrobial resistance and informing improvement in antimicrobial stewardship

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          Abstract

          Objectives

          To explore the accuracy of application of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool in epidemiological studies focused on the evaluation of the role of antibiotics in selecting resistance, and to derive and test an extension of STROBE to improve the suitability of the tool in evaluating the quality of reporting in these area.

          Methods

          A three-step study was performed. First, a systematic review of the literature analysing the association between antimicrobial exposure and acquisition of methicillin-resistant Staphylococcus aureus and/or multidrug-resistant Acinetobacter baumannii was performed. Second, articles were reviewed according to the STROBE checklist for epidemiological studies. Third, a set of potential new items focused on antimicrobial-resistance quality indicators was derived through an expert two-round RAND-modified Delphi procedure and tested on the articles selected through the literature review.

          Results

          The literature search identified 78 studies. Overall, the quality of reporting appeared to be poor in most areas. Five STROBE items, comprising statistical analysis and study objectives, were satisfactory in <25% of the studies. Informative abstract, reporting of bias, control of confounding, generalisability and description of study size were missing in more than half the articles. A set of 21 new items was developed and tested. The new items focused particularly on the study setting, antimicrobial usage indicators, and patients epidemiological and clinical characteristics. The performance of the new items in included studies was very low (<25%).

          Conclusions

          Our paper reveals that reporting in epidemiological papers analysing the association between antimicrobial usage and development of resistance is poor. The implementation of the newly developed STROBE for antimicrobial stewardship (AMS) tool should enhance appropriate study design and reporting, and therefore contribute to the improvement of evidence to be used for AMS programme development and assessment.

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          Most cited references14

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          Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.

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            The Delphi technique: a methodological discussion.

            As in nursing, recent curriculum reform in radiographer education has resulted in the development of undergraduate programmes, and a study referred to in this paper investigated the activities of supervising radiographers in support of the undergraduate curriculum. Following on from 'ward learning environments' research in nursing, the most important activities which assist radiography students' clinical learning were investigated by means of the Delphi technique. At the design stage, a deficiency in previous work using the technique was identified, in that decisions relating to consensus among research respondents appeared to be based on arbitrary or post hoc rationales rather than predetermined or objective criteria. As the Delphi technique is being increasingly employed in nursing and similar research, it is important to explore issues of consensus, validity and reliability. The paper makes recommendations for improving these aspects in future studies.
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              Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: a time-series analysis.

              Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. A wide range of factors have been suggested to influence the spread of MRSA. The objective of this study was to evaluate the effect of antimicrobial drug use and infection control practices on nosocomial MRSA incidence in a 426-bed general teaching hospital in Northern Ireland. The present research involved the retrospective collection of monthly data on the usage of antibiotics and on infection control practices within the hospital over a 5 year period (January 2000-December 2004). A multivariate ARIMA (time-series analysis) model was built to relate MRSA incidence with antibiotic use and infection control practices. Analysis of the 5 year data set showed that temporal variations in MRSA incidence followed temporal variations in the use of fluoroquinolones, third-generation cephalosporins, macrolides and amoxicillin/clavulanic acid (coefficients = 0.005, 0.03, 0.002 and 0.003, respectively, with various time lags). Temporal relationships were also observed between MRSA incidence and infection control practices, i.e. the number of patients actively screened for MRSA (coefficient = -0.007), the use of alcohol-impregnated wipes (coefficient = -0.0003) and the bulk orders of alcohol-based handrub (coefficients = -0.04 and -0.08), with increased infection control activity being associated with decreased MRSA incidence, and between MRSA incidence and the number of new patients admitted with MRSA (coefficient = 0.22). The model explained 78.4% of the variance in the monthly incidence of MRSA. The results of this study confirm the value of infection control policies as well as suggest the usefulness of restricting the use of certain antimicrobial classes to control MRSA.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2016
                19 February 2016
                : 6
                : 2
                : e010134
                Affiliations
                [1 ]Division of Infectious Diseases, Department of Internal Medicine I, University Hospital , Tübingen, Germany
                [2 ]German Centre for Infection Research (DZIF) , Tübingen, Germany
                [3 ]National Institute for Infectious Diseases “Lazzaro Spallanzani”, 2nd Infectious Disease Division , Rome, Italy
                [4 ]Department of Infectious Diseases, Rambam Health Care Campus , Haifa, Israel
                [5 ]Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University , Petach-Tikva, Israel
                [6 ]Amphia Hospital Breda and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, location Molengracht, Laboratory for Microbiology and Infection Control , Breda, The Netherlands
                [7 ]Institute of Public Health, Catholic University of the Sacred Heart , Rome, Italy
                [8 ]Department of Infectious Diseases, Heidelberg University Hospital , Heidelberg, Germany
                [9 ]Institute for Hygiene and Environmental Health, Charité, Medical University Berlin , Berlin, Germany
                [10 ]Department of Infection and Immunity, University College London, London University , London, UK
                Author notes
                [Correspondence to ] Professor Evelina Tacconelli; Evelina.Tacconelli@ 123456med.uni-tuebingen.de
                Article
                bmjopen-2015-010134
                10.1136/bmjopen-2015-010134
                4762075
                26895985
                2e145704-7303-4131-ad8c-a9a3596a3380
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 30 September 2015
                : 3 December 2015
                : 18 December 2015
                Categories
                Infectious Diseases
                Research
                1506
                1706
                1692

                Medicine
                reporting,antibiotic resistance,mrsa,mdr-acinetobacter,antimicrobial stewarsdhip
                Medicine
                reporting, antibiotic resistance, mrsa, mdr-acinetobacter, antimicrobial stewarsdhip

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