Clinical Implication of the Relationship between Antimicrobial Resistance and Infection Control Activities in Japanese Hospitals: A Principal Component Analysis-Based Cluster Analysis
Abstract
:1. Introduction
2. Results
3. Discussion
4. Materials and Methods
4.1. Data Source
4.2. Study Inclusion and Exclusion Criteria
4.3. Variable Definitions and Facility Categories
4.4. Principal Component Analysis and Cluster Analysis
4.5. Statistical Analyses
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Eigenvalue | % of Variance | Eigenvector | |
---|---|---|---|
Principal component 1: “Bacterial tests” | 2.49 | 24.9 | |
Number of bacterial tests | 0.52 | ||
Blood culture collected prior to broad spectrum antibiotic therapy | 0.49 | ||
Number of CD detected test | 0.42 | ||
Principal component2: “Operations” | 1.47 | 14.8 | |
Rate of surgeries | 0.53 | ||
Region | −0.58 | ||
Average length of stay | 0.44 | ||
Principal component 3: “Ability of ICT” | 1.29 | 12.9 | |
TDM implementation rate for vancomycin | 0.41 | ||
Medical fee for IPC type 1 | 0.60 | ||
Contamination of blood cultures | −0.4 | ||
Principal component 4: “Skill in performing blood cultures” | 1.08 | 10.8 | |
Multiple sets of blood culture | −0.7 | ||
Contamination of blood cultures | 0.51 |
Cluster 1 (n = 25) | Cluster 2 (n = 13) | Cluster 3 (n = 5) | Cluster 4 (n = 49) | Cluster 5 (n = 31) | Overall p-Value g | |
---|---|---|---|---|---|---|
Structure factors | ||||||
Number of beds (beds) | 269 (190–490) | 275 (218–559) | 106 (100–163) e | 304 (210–377) e | 466 (337–505) c,d | 0.0002 |
Number of patients admissions per year (patients) | 6303 (4291–11901) | 5789 (3952–12,996) c | 2587 (1919–2962) b,d,e | 6184 (4429–9231) c | 11,046 (8988–13,612) c,d | <0.001 |
Average length of stay (days) | 12.5 (11.2–13.4) | 13.4 (10.7–14.8) | 14.9 (13.2–20.4) e | 13.2 (11.7–15) e | 10.9 (9.9–11.8) c,d | <0.001 |
Rate of surgeries (%) f | 22.1 ± 4.8 d | 25.3 ± 4.7 | 29.1 ± 6.3 | 29.3 ± 5.4 a,e | 25.3 ± 3.7 d | 0.0055 g |
ICU patient admissions (%) | 3.0 (0–9.5) | 0 (0–5.5) | 0 (0–0) | 0 (0–4.6) | 3.7 (0–4.9) | 0.0365 |
CVC use patients (%) | 6.1 (4.7–9.6) | 8.0 (5.0–9.7) c | 3.1 (1.7–4.7) b,e | 5.6 (3.9–8.0) | 6.4 (4.7–8.1) c | 0.0159 |
UC use patients (%) | 13.3 (9.2–18.7) | 12.3 (9.4–14.4) | 14.2 (11.2–21.6) | 12.1 (9.8–13.4) | 12.0 (8.6–15.1) | 0.3219 |
Region (East Japan: %) | 92.0 | 84.6 | 0 | 36.7 | 70.9 | |
Medical fee for IPC type 1 (%) | 84.0 | 100 | 0 | 100 | 100 | |
Teaching Hospital (%) | 76.0 | 92.3 | 60.0 | 87.8 | 96.7 | |
7:1 hospital charge index (%) | 92.0 | 100 | 100 | 94.0 | 100 | |
Pharmaceutical service (%) | 64.0 | 76.9 | 40.0 | 65.3 | 64.5 | |
Process factors | ||||||
TDM implementation rate for vancomycin (%) | 64.3 (40.3–73.0) b,d,e | 82.1 (60.5–86.8) a | 9.7 (4.9–61.5) d,e | 80.0 (71.4–87.3) a,c | 80.8 (76.3–88.7) a,c | <0.001 |
Multiple sets of blood cultures (%) | 80.6 (66.5–86.5) b | 46.3 (13.7–51.5) a,c,d,e | 78.0 (74.5–88.5) b | 82.3 (75.2–87.3) b | 85.0 (74.0–92.4) b | <0.001 |
Contamination of blood cultures (%) | 4.0 (2.5–4.9) | 4.1 (1.3–9.2) | 3.5 (2.6–5.3) | 3.0 (1.8–4.2) | 2.4 (1.9–3.7) | 0.0988 |
Number of CD detected test (/1000 bed-days) | 3.8 (1.5–5.1) | 3.7 (2.5–4.9) | 4.4 (1.6–8.2) | 3.8 (2.5–4.6) e | 5.4 (4–6.1) d | 0.0114 |
Blood culture collected prior to broad spectrum antibiotic therapy (%) | 40.6 (34.8–53.6) d,e | 60.9 (37.7–74.8) | 30.1 (21.4–45.1) e | 59.2 (41.8–64.6) a,e | 72.3 (66.3–79.6) a,c,d | <0.001 |
Specimens for culture prior to broad spectrum antibiotic therapy (%) | 72.8 (63.4–80.4) d,e | 87.3 (72.3–90.2) | 63.0 (43.9–68.4) e | 81.8 (74.6–85.7) a,e | 85.9 (83.5–92.3) a,c,d | <0.001 |
Number of bacterial tests (/100 bed-days) | 6.8 (5.6–9.4) e | 10.3 (7.2–11.1) e | 6.7 (2.4–9.3) e | 8.5 (6.5–10.5) e | 14.6 (11.6–19.0) a,b,c,d | <0.001 |
AUD of antibiotic injection (/100 bed-days) | 15.4 (12.1–17.4) e | 18.3 (14.1–20.2) | 12.8 (10.5–16.7) | 14.5 (11.1–16.0) e | 19.1 (17.2–21.9) a,d | <0.001 |
DOT of antibiotic injection (/100 bed-days) | 25.6 (21.7–28.4) e | 28.3 (26.1–31.4) d | 24.9 (16.7–26.3) | 23.5 (19.6–26.8) b,e | 30.1 (26.6–32.3) a,d | <0.001 |
Name | Units | Definition |
---|---|---|
Structure factors | ||
Number of beds | Beds | Number of hospital beds |
Number of admissions patients per year | Patients | |
Average length of stay | Days | |
Rate of surgeries | % | Number of JANIS SSI surveillance/Number of all surgeries × 100 |
ICU admission patients | % | ICU admission patients/Number of admission patients per year |
CVC patients | % | Number of Central Venous Catheter used patients/Number of admission patients per year × 100 |
UC patients | % | Number of urinary Catheter used patients/Number of admission patients per year × 100 |
Region | % | West Japan = 0, East Japan = 1 |
Medical fee for IPC type 1 | % | Medical fee for IPC type 2 = 0, Medical fee for IPC type 1 = 1 |
Teaching Hospital | % | Non-Teaching Hospital = 0, Teaching Hospital = 1 |
7:1 hospital charge index | % | 10:1 hospital charge index = 0, 7:1 hospital charge index = 1 |
Pharmaceutical service | % | Non-Pharmaceutical service = 0, Pharmaceutical service = 1 |
Process factors | ||
TDM implementation rate for vancomycin | % | TDM performed patients in denominator/Patient treatment duration >3 days for vancomycin |
Multiple sets of blood culture | % | Number of patients in whom multiple blood cultures were taken/Total number of patients who blood cultures were taken |
Contamination of blood cultures | % | Number of contaminated cultures/Number of patients in whom multiple blood cultures were taken |
Number of CD detected tests | /1000 bed-days | Number of CD detected tests/length of hospital stay for inpatients × 1000 |
Blood culture collected prior to broad spectrum antibiotic therapy | % | Before starting broad spectrum systemic antibiotic therapy in hospitalized adults with at least one blood culture/Admitted broad spectrum systemic antibiotic therapy |
Specimens for culture prior to broad spectrum antibiotic therapy | % | Before starting broad spectrum systemic antibiotic therapy in hospitalized adults with bacterial culture/Admitted broad spectrum systemic antibiotic therapy |
Number of bacterial tests | /100 bed-days | Number of bacterial tests/length of hospital stay for inpatients × 100 |
AUD of antibiotic injection | /100 bed-days | Antimicrobial consumptions (g)/(DDD a × length of hospital stay for inpatients) × 100 |
DOT of antibiotic injection | /100 bed-days | DOT/length of hospital stay for inpatients × 100 |
Antimicrobial resistance | ||
MRSA/S. aureus detection rate | % | MRSA detected patients/Number of MRSA + MSSA detected patients × 100 |
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Characteristics | Hospital Baseline (n = 124) |
---|---|
Structure factors | |
Number of beds (beds) a | 330 (223–478) |
Number of patients admissions per year (patients) a | 7099 (4576–11284) |
Average length of stay (days) | 12.4 (11.1–14.1) |
Rate of surgeries (%) b | 26.5 (5.6) |
ICU patient admissions (%) a | 0.3 (0–4.9) |
CVC use patients (%) a | 6.0 (4.6–8.5) |
UC use patients (%) a | 12.2 (9.4–15.1) |
Region (East Japan: %) | 59.7 |
Medical fee for IPC type 1 (%) | 92.7 |
Teaching Hospital (%) a | 87.1 |
7:1 hospital charge index (%) a | 96.0 |
Pharmaceutical service (%) a | 65.3 |
Process factors | |
TDM implementation rate for vancomycin (%) | 79.2 (67.0–84.9) |
Multiple sets of blood cultures (%) | 81.1 (68.7–88.5) |
Contamination of blood cultures (%) | 3.1 (1.9–4.6) |
Number of CD detected test (/1000 bed days) | 4.2 (2.6–5.4) |
Blood culture collected prior to broad spectrum antibiotic therapy (%) c | 60.1 (40.8–71.5) |
Specimens for culture prior to broad spectrum antibiotic therapy (%) a,c | 82.4 (72.6–88.4) |
Number of bacterial tests (/100 bed days) | 9.8 (6.7–12.9) |
AUD of antibiotic injection (/100 bed days) a | 15.8 (12.8–19.1) |
DOT of antibiotic injection (/100 bed days) a | 26.3 (22.4–30.3) |
Antimicrobial resistance | |
MRSA/S. aureus detection rate a | 42.3 (33.3–52.5) |
Cluster 1 (n = 25) | Cluster 2 (n = 13) | Cluster 3 (n = 5) | Cluster 4 (n = 49) | Cluster 5 (n = 31) | Overall p-Value | |
---|---|---|---|---|---|---|
Structure factors | ||||||
Number of beds (beds) | 269 | 275 | 106 e | 304 e | 466 c,d | 0.0002 |
Number of patients admissions per year (patients) | 6303 | 5789 c | 2587 b,d,e | 6184 c | 11,046 c,d | <0.001 |
Average length of stay (days) | 12.5 | 13.4 | 14.9 e | 13.2 e | 10.9 c, d | <0.001 |
Rate of surgeries (%) f | 22.1 ± 4.8 | 25.3 ± 4.7 | 29.1 ± 6.3 | 29.3 ± 5.4 a,e | 25.3 ± 3.7 d | 0.0055 g |
ICU patient admissions (%) | 3.0 | 0 | 0 | 0 | 3.7 | 0.0365 |
CVC use patients (%) | 6.1 | 8.0 c | 3.1 b,e | 5.6 | 6.4 c | 0.0159 |
UC use patients (%) | 13.3 | 12.3 | 14.2 | 12.1 | 12.0 | 0.3219 |
Region (East Japan: %) | 92.0 | 84.6 | 0 | 36.7 | 70.9 | |
Medical fee for IPC type 1 (%) | 84.0 | 100 | 0 | 100 | 100 | |
Teaching Hospital (%) | 76.0 | 92.3 | 60.0 | 87.8 | 96.7 | |
7:1 hospital charge index (%) | 92.0 | 100 | 100 | 94.0 | 100 | |
Pharmaceutical service (%) | 64.0 | 76.9 | 40.0 | 65.3 | 64.5 | |
Process factors | ||||||
TDM implementation rate for vancomycin (%) | 64.3 b,d,e | 82.1 a | 9.7 d,e | 80.0 a,c | 80.8 a,c | <0.001 |
Multiple sets of blood cultures (%) | 80.6 b | 46.3 a,c,d,e | 78.0 b | 82.3 b | 85.0 b | <0.001 |
Contamination of blood cultures (%) | 4.0 | 4.1 | 3.5 | 3.0 | 2.4 | 0.0988 |
Number of CD detected test (/1000 bed days) | 3.8 | 3.7 | 4.4 | 3.8 e | 5.4 d | 0.0114 |
Blood culture collected prior to broad spectrum antibiotic therapy (%) | 40.6 d,e | 60.9 | 30.1 e | 59.2 a,e | 72.3 a,c,d | <0.001 |
Specimens for culture prior to broad spectrum antibiotic therapy (%) | 72.8 d,e | 87.3 | 63.0 e | 81.8 a,e | 85.9 | <0.001 |
Number of bacterial tests (/100 bed days) | 6.8 e | 10.3 e | 6.7 e | 8.5 e | 14.6 a,b,c,d | <0.001 |
AUD of antibiotic injection (/100 bed days) | 15.4 e | 18.3 | 12.8 | 14.5 e | 19.1 a,d | <0.001 |
DOT of antibiotic injection (/100 bed days) | 25.6 e | 28.3 d | 24.9 | 23.5 b,e | 30.1 a,d | <0.001 |
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Shoji, T.; Sato, N.; Fukuda, H.; Muraki, Y.; Kawata, K.; Akazawa, M. Clinical Implication of the Relationship between Antimicrobial Resistance and Infection Control Activities in Japanese Hospitals: A Principal Component Analysis-Based Cluster Analysis. Antibiotics 2022, 11, 229. https://doi.org/10.3390/antibiotics11020229
Shoji T, Sato N, Fukuda H, Muraki Y, Kawata K, Akazawa M. Clinical Implication of the Relationship between Antimicrobial Resistance and Infection Control Activities in Japanese Hospitals: A Principal Component Analysis-Based Cluster Analysis. Antibiotics. 2022; 11(2):229. https://doi.org/10.3390/antibiotics11020229
Chicago/Turabian StyleShoji, Tomokazu, Natsu Sato, Haruhisa Fukuda, Yuichi Muraki, Keishi Kawata, and Manabu Akazawa. 2022. "Clinical Implication of the Relationship between Antimicrobial Resistance and Infection Control Activities in Japanese Hospitals: A Principal Component Analysis-Based Cluster Analysis" Antibiotics 11, no. 2: 229. https://doi.org/10.3390/antibiotics11020229