Identification of antibiotic consumption targets for the management of Clostridioides difficile infection in hospitals- a threshold logistic modelling approach.

BACKGROUND: This study aims to demonstrate the utility of a threshold logistic approach to identifying thresholds for specific antibiotic use associated with Clostridioides difficile infection (CDI) in an English teaching hospital. METHODS: A combined approach of nonlinear modeling and logistic regression, named threshold logistic, was used to identify thresholds and risk scores in hospital-level antibiotic use associated with hospital-onset, healthcare-associated (HOHA) CDI cases. RESULTS: Using a threshold logistic regression approach, an incidence greater than 0.2645 cases/1000 occupied bed-days (OBD; 85th percentile) was determined as the cutoff rate to define a critical (high) incidence rate of HOHA CDI. Fluoroquinolones and piperacillin-tazobactam were found to have thresholds at 84.8 and 54 defined daily doses (DDD)/1000 OBD, respectively. Analysis of data allowed calculating risk scores for HOHA CDI incidence rates exceeding the 85th percentile, i.e. entering critical incidence level. The threshold-logistic model also facilitated performing 'what-if scenarios' on future values of fluoroquinolones and piperacillin-tazobactam use to understand how HOHA CDI incidence rates may be affected. CONCLUSION: Using threshold logistic analysis, critical incidence levels and antibiotic use targets to control HOHA CDI were determined. Threshold logistic models can be used to inform and enhance the effective design and implementation of antimicrobial stewardship programs.

Good for a national cemetery: questions of land use and an 1888 Botanical Expedition across Northern Michigan.

In the second half of the nineteenth century, lumbermen logged the virgin pine forests of northern Michigan. The assumption was that the "plow would follow the axe," and agriculture would dominate the region as it did in the southern half of the state. When farming did not quickly take root, William James Beal and Liberty Hyde Bailey led an expedition of scientists and journalists on a trip across northern Michigan in June 1888 to collect botanical samples, to find a site for a state forest reserve, and to recommend appropriate farming enterprises. This essay contends that without a key reforestation advocate in charles Garfield the explorers focused too much on the questions related to botany and agriculture.While agriculture would ultimately thrive in some parts of the cutover, much of the region was unsuitable for intensive farming. The failure of the scientists to convey these limits adequately in newspaper articles and subsequent reports allowed for their work to be used by agricultural boosters throughout the region. The result was a cycle of erosion, fire, and farm abandonment that proved to be a political problem in Michigan for the first three decades of the twentieth century.