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

Geraldine Mary Conlon-Bingham, Mamoon Aldeyab, Michael Scott, Mary Patricia Kearney, David Farren, Fiona Gilmore, James McElnay

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11 Citations (Scopus)
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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.
Original languageEnglish
Pages (from-to)52-62
Number of pages11
JournalEmerging Infectious Diseases
Issue number1
Publication statusPublished - 01 Jan 2019


  • antibiotic cycling
  • antimicrobial drug resistance
  • bacteria
  • CDI
  • Clostridioides difficile
  • Clostridium difficile
  • ESBL
  • extended-spectrum β-lactamase
  • healthcare-acquired infections
  • Ireland
  • methicillin-resistant Staphylococcus aureus
  • MRSA
  • nosocomial infections


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