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Interrupted Time-Series of Antimicrobial Stewardship in a Hospital Network

Hospital-level antimicrobial stewardship programmes serve as crucial epidemiological and clinical interventions designed to curb unnecessary antimicrobial consumption and suppress antimicrobial resistance. Quasi-experimental interrupted time-series methodologies provide robust longitudinal evaluation of prescribing alterations and clinical outcomes across hospital network environments. Systematic synthesis of multi-centre time-series evidence highlights both immediate level changes and sustained trend trajectories following institutional stewardship interventions.

Objectiu del treball

How do hospital network antimicrobial stewardship programmes alter longitudinal prescribing patterns and resistance burdens under interrupted time-series evaluation?

Metodologia

Quasi-experimental synthesis of longitudinal interrupted time-series studies across hospital networks evaluating antimicrobial consumption and microbiological resistance.

Novetat científica

Synthesizes multi-centre interrupted time-series evidence to delineate immediate versus slope changes in network antimicrobial utilization and distinct pathogen resistance outcomes.

Previsualització del document

Aquesta és una previsualització breu. La versió completa inclou text ampliat per a totes les seccions, una conclusió i una bibliografia formatada.

Master's Thesis

Degree:
Interrupted Time-Series of Antimicrobial Stewardship in a Hospital Network

Author:

Group

First M. Last

Advisor:

Dr. First Last

City, 2026

Contents

Introduction
Theoretical Foundations of Antimicrobial Stewardship in Hospital Networks
Mechanisms of Antimicrobial Resistance and Inpatient Selection Pressures
Structural Governance and Multidisciplinary Stewardship Teams
Methodological Framework of Interrupted Time-Series in Healthcare Systems
Segmented Regression Modelling and Autocorrelation Adjustments
Metrics of Consumption and Microbiological Outcome Indicators
Longitudinal Trajectories of Inpatient Prescribing and Pathogen Resistance
Immediate Level Reductions and Slope Shifts in Utilization
Divergence Between Hospital-Acquired and Community-Acquired Organisms
Resilience of Stewardship Practices During Epidemic Surges
Synthesis of Longitudinal Antimicrobial Stewardship Outcomes across Network Settings
Systemic Disparities and Unit-Specific Prescribing Variations
Methodological Constraints and Unmeasured Confounders
Strategic Implications for Hospital Network Policy and Stewardship
Integration of Audit and Feedback Systems into Clinical Workflow
Sustainable Network Surveillance and Policy Coordination
Conclusion
Bibliography

Introduction

Antimicrobial resistance represents a pre-eminent threat to contemporary public health systems and inpatient safety across hospital networks. Within complex acute care environments, unchecked therapeutic exposure accelerates the selective emergence of multidrug-resistant pathogens and elevates patient morbidity [5]. Multi-centre antimicrobial stewardship programmes offer structured clinical governance frameworks designed to rationalise antimicrobial prescribing, reduce inappropriate broad-spectrum therapy, and curb nosocomial transmission across institutional care settings [3].

Measuring the definitive causal efficacy of stewardship interventions across hospital networks presents distinct methodological hurdles due to baseline secular trends and seasonal prescribing variations. Conventional pre- and post-intervention comparisons often conflate systemic clinical policy changes with unmeasured external confounders [1]. Segmented interrupted time-series models resolve these analytical obstacles by establishing longitudinal baseline trajectories and statistically quantifying immediate level shifts alongside sustained post-intervention trend changes across interconnected healthcare facilities [5].

Extensive multi-centre evaluations indicate that comprehensive stewardship frameworks incorporating prospective audit and feedback deliver substantial decreases in institutional antibiotic consumption and hospital-acquired resistant isolates [3], [5]. Furthermore, longitudinal network surveillance demonstrates that institutionalised stewardship services maintain prescribing discipline and prevent prolonged antimicrobial surges during external acute care shocks, including respiratory pandemic waves across medical and intensive care units [1].

This paper critically synthesises longitudinal evidence to evaluate how network-level antimicrobial stewardship initiatives influence consumption patterns and pathogen resistance dynamics. By examining quasi-experimental interrupted time-series evidence, the inquiry delineates unit-specific prescribing trajectories, methodological considerations in regression modelling, and structural governance mechanisms required to sustain clinical improvements across modern Canadian and international hospital networks [1], [3], [5].

Synthesis of Longitudinal Antimicrobial Stewardship Outcomes across Network Settings

The longitudinal evaluation of hospital network antimicrobial stewardship through interrupted time-series regression demonstrates that coordinated interventions exert a measurable inhibitory effect on antimicrobial selection pressure. Controlled multi-centre evidence confirms that hospital-wide stewardship, incorporating pharmacist-led audit and feedback, generates significant downward shifts in the incidence of hospital-acquired antibiotic-resistant organisms despite concurrent increases in community-acquired resistance rates (crossref-10-1093-cid-ciz1183, 2019). Furthermore, multi-centre time-series observations across Canadian acute care settings reveal that initial prescribing surges during epidemiological disruptions can successfully normalize to baseline levels as clinical practice guidelines adapt, underscoring the structural resilience of established stewardship services across medical and intensive care units (crossref-10-1017-ash-2022-268, 2022). Notwithstanding these demonstrable prescribing shifts, a critical research gap persists regarding how network-level interventions translate across divergent inpatient unit types and complex patient sub-populations. Current scholarly syntheses frequently aggregate institutional metrics, thereby obscuring unit-specific dynamics and non-linear transmission vectors that operate independently of aggregate consumption. Additionally, methodological constraints remain pronounced in existing literature. Segmented regression models are inherently susceptible to unmeasured time-varying confounders, such as shifting diagnostic threshold practices, unmeasured infection prevention protocols, and regional patient transfers. Furthermore, observational time-series designs struggle to isolate the specific contributions of individual stewardship bundle components when multidisciplinary policies are deployed simultaneously. Consequently, while longitudinal time-series analyses substantiate the aggregate utility of stewardship frameworks, rigorous multi-centre evaluations must integrate granular ward-level stratification and pathogen-specific resistance tracing to establish durable causal mechanisms across interconnected hospital…

References

  1. Trends in hospital antibiotic utilization during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter interrupted time-series analysis
    Marion Elligsen, Michael Wan, Philip W. Lam et al.
    Lien DOI
  2. Impact of antibiotic restriction on resistance levels of<i>Escherichia coli</i>: a controlled interrupted time series study of a hospital-wide antibiotic stewardship programme
    Jonas Boel, Viggo Andreasen, Jens Otto Jarløv et al.
    Lien DOI
  3. Impact of an antimicrobial stewardship programme on antibiotic utilization and resistance burden in patients with acute leukaemia: an 11-year longitudinal cohort study using interrupted time-series analysis
    Raeseok Lee, Dukhee Nho, Sung-Yeon Cho et al.
    Lien DOI
  4. Interrupted time-series analysis to evaluate the impact of a national antimicrobial stewardship campaign on antibiotic use among primary healthcare institutions: evidence from Central China
    Yirui Xu, Yingying Wang, Hanyu Qian et al.
  5. Impact of a Comprehensive Antimicrobial Stewardship Program on Institutional Burden of Antimicrobial Resistance: A 14-Year Controlled Interrupted Time-series Study
    Christine Peragine, Sandra A N Walker, Andrew Simor et al.
  6. Impact of a Pharmacist-Led Grid-Based Stewardship Program on the Association Between Antimicrobial Use and Resistance: A 7.5-Year Interrupted Time-Series Analysis in a Chinese Tertiary Hospital
    Zhao Mei, Li Zhou, Yueqing Tan et al.
  7. Effect of national antimicrobial resistance policies on antibiotic prescribing rates in South Korea: an interrupted time series analysis
    Jin Suk Kim, Seog-Kyun Mun
  8. The Impact of a National Antimicrobial Stewardship Program on Antibiotic Prescribing in Primary Care: An Interrupted Time Series Analysis
    Violeta Balinskaite, Alan P Johnson, Alison Holmes et al.

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