Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis

Tacconelli, Evelina; Angelis, Giulia De; Cataldo, Maria Adriana; Pozzi, Elisabetta; Cauda, Roberto

doi:10.1093/jac/dkm416

Cited by 366 publications

(259 citation statements)

References 126 publications

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“…4,[9][10][11][12][13][14][15][16][17][18][20][21][22][23][25][26][27][28]33,34 Obviously, differences in our results compared to the above-described studies may be partly due to different study design and differences in populations studied, as noted in a recent meta-analysis. 38 Additionally, from a subanalysis of the blood isolates of our study groups, the mean number of antibiotic-days did emerge as independent predictor of a subsequent HCA-MRSA bacteremia. 45 …”

Section: Resultsmentioning

confidence: 70%

“…These results are in agreement with prior studies, looking at qualitative use of those antibiotics. 6,11,12,14,22,[26][27][28][29][33][34][35][36][37][38] Additionally, use of at least two different antibiotics during the previous month was at the border of statistical significance. The underlying mechanisms have not been completely clarified but several lines of evidence exist.…”

Section: Antibiotic Usementioning

confidence: 99%

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Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Baraboutis¹,

Tsagalou²,

Papakonstantinou³

et al. 2011

Braz J Infect Dis

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Objectives: Both total antimicrobial use and specific antimicrobials have been implicated as risk factors for healthcare-associated methicillin-resistant Staphylococcus aureus (HCA-MRSA) infection. The aims of this study were: (I) to explore predictors of a new HCA-MRSA infection in comparison with a new healthcare-associated methicillin-sensitive Staphylococcus aureus (HCA-MSSA); (II) to thoroughly assess the role of recent antibiotic use qualitatively and quantitatively. Methods: The time-period for our study was from October 1997 through September 2001. Through applying strict criteria, we identified two groups of inpatients, one with a new HCA-MRSA infection and one with a new HCA-MSSA infection. We recorded demographic, clinical and antibiotic use-related data up to 30 days before the positive culture date. Results: We identified 127 and 70 patients for each group, respectively. Two logistic regression models were carried out to assess the role of antimicrobial use (qualitatively and quantitatively). In model I, duration of hospital stay, presence of chronic wounds, aminoglycoside and fluoroquinolone use retained statistical significance. In model II, duration of hospital stay and history of intubation during the last month stood out as the only significant predictors of a subsequent HCA-MRSA infection. No significant differences in outcome were noted. Conclusions: The length of exposure to the hospital environment may be the best predictor of a new HCA-MRSA infection. Use of aminoglycosides and fluoroquinolones may also stand independently along with presence of chronic ulcers and surgical procedures. No independent association between quantitative antibiotic use and subsequent HCA-MRSA infection was documented. Keywords: methicillin-resistant Staphylococcus aureus; Staphylococcus aureus; antibacterial agents; fluoroquinolones. significant risk factor for MRSA acquisition and infection from most, but not all, case-control and cohort studies. 4,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Both total antimicrobial use as well as specific antimicrobial classes have been implicated. [11][12][13][14][15][16][17][18]24,25 Included in these classes are β-lactamic antibiotics, 14,26-33 cephalosporins, 11,12,16,22,29 aminoglycosides, 22,33,34 macrolides, 27 glycopeptides 15,[27][28][29]34 and fluoroquinolones (FQs). 6,11,12,14,[26][27][28][29][35][36][37] A relatively recently published meta-analysis detected a clear association between exposure to antibiotics and MRSA isolation. Significant risk ratios were found for FQs, glycopeptides, cephalosporins and other β-lactams. 38 A prediction model, aimed at identifying MRSA bacteremia, predicted that 80% of the nosocomial bacteremias would be resistant to methicillin if patients had experienced antimicrobials prior to the onset. This model also indicated that there were no differences between antibiotics in the prediction of MRSA. 29

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Section: Resultsmentioning

confidence: 70%

Section: Antibiotic Usementioning

confidence: 99%

Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Baraboutis¹,

Tsagalou²,

Papakonstantinou³

et al. 2011

Braz J Infect Dis

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“…Taken together, these results suggest that the rate of pyogenic spondylitis may be higher in Japan. MRSA infection is significantly associated with immuno-compromised hosts, longer hospitalizations before infection, and longer antibiotic therapy (Tacconelli et al 2008;Yamada et al 2011;Sasaji et al 2012). According to the data from the Organization for Economic Cooperation and Development (OECD) in 2007, the average days of hospitalization in Japan was 35.7, whereas in the United States of America the average was 6.5, in the United Kingdom it was 7.0.…”

Section: Discussionmentioning

confidence: 99%

“…In addition in Japan, once a patient develops fever-up, antibiotics are often prescribed without specifically discerning the cause of the fever. Such uncontrolled use of antibiotics can produce antibiotic-resistant mutated microorganisms (Tacconelli et al 2008). Longer hospitalization and uncontrolled use of antibiotics in Japan may result in high infection rates with methicillin-resistant staphylococci leading to spondylitis (Yoshimoto et al 2011;Sasaji et al 2012).…”

Section: Discussionmentioning

confidence: 99%

Atypical Findings on Magnetic Resonance Imaging in the Patients with Active Pyogenic Spondylitis in Japanese University Hospitals

Aizawa

Ozawa

Koakutsu

et al. 2013

Tohoku J. Exp. Med.

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Recently, aging population and immuno-compromised patients have been rising in Japan. Accordingly, patients with pyogenic spondylitis have been increasing and may present atypical clinical features. University hospitals treat many elderly patients and patients with poor general condition. Therefore, patients with pyogenic spondylitis treated at two university hospitals were retrospectively investigated to clarify the recent clinical and radiologic characteristics of this infection. There were 30 patients (average age: 68 years) treated in two university hospitals between 2009 and 2010. The onset was acute or subacute in 15 patients, insidious in 7 and unclassified in 8. Culture tests were performed in 25 patients, and the causative microorganisms were identified in 20 patients with the identification rate of 80%, including 4 patients infected by methicillin-resistant staphylococci. Classically, active pyogenic spondylitis is characterized by typical findings on magnetic resonance imaging (MRI): obvious signal decrease in T1-weighted image (WI) and increase in T2WI with contrast enhancement found in most of the bodies of two adjacent vertebrae and the intervening intervertebral disc. Among 29 patients with active pyogenic spondylitis, whose lesions were not in the healing stage, 16 patients demonstrated at least one of the atypical MRI findings; 9 patients showed involvement ≥ 3 vertebrae or only 1 vertebra, 5 showed the signal changes of the lesions involving small, spotty, or faint areas, and 3 showed small vertebral lesions but larger epidural or paraspinal abscesses. In conclusion, currently, about half of the patients with pyogenic spondylitis demonstrate atypical MRI findings in the university hospitals in Japan.

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“…Nosocomial infections pose a significant threat to patients worldwide, and antibiotic-resistant bacteria are related to a greater impact on morbidity/ mortality and the costs of such infections [1][2][3] . Ventilator-associated pneumonia (VAP) is the most frequent infection acquired in the intensive care unit (ICU), occurring in 9% to 24% of patients intubated for longer than 48h 4,5 .…”

Section: Article/artigomentioning

confidence: 99%

Relationship between antibiotic consumption, oropharyngeal colonization, and ventilator-associated pneumonia by Staphylococcus aureus in an intensive care unit of a Brazilian teaching hospital

Moreira

Filho

2012

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: his study evaluated the consumption of major classes of antibiotics, the colonization of the oropharynx of patients on mechanical ventilation, and the risk of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus in an intensive care unit for adults. METHODS: A case-control study was carried out using colonized patients (cases) by oxacillin-resistant S. aureus (ORSA) and (controls) oxacillin-sensitive S. aureus (OSSA) from May 2009 to August 2010. The occurrence of VAP by S. aureus was also evaluated in the same period. Antibiotic consumption was expressed as the number of defined daily doses (DDD)/1,000 patient-days for glycopeptides, carbapenems, and extended-spectrum cephalosporins. RESULTS: Three hundred forty-six (56.1%) patients underwent mechanical ventilation with a frequency of oropharyngeal colonization of 36.4%, corresponding to 63.5% for ORSA and 36.5% for OSSA. The risk of illness for this organism was significant (p<0.05), regardless of whether colonization/infection was by ORSA or OSSA. The consumption of antibiotics was high, mainly for broad-spectrum cephalosporins (551.26 DDDs/1,000 patient-days). The high density of use of glycopeptides (269.56 DDDs/1,000 patient-days) was related to colonization by ORSA (Pearson r=0.57/p=0.02). Additionally, age >60 years, previous antibiotic therapy, and previous use of carbapenems were statistically significant by multivariate analysis. CONCLUSIONS: There was a significant relationship between the colonization of the oropharyngeal mucosa and the risk of VAP by both phenotypes. The use of glycopeptides was related to colonization by ORSA.

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Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis

Abstract: This meta-analysis shows a clear association between exposure to antibiotics and MRSA isolation. This information may be useful for researchers in designing future studies and for policy decision-making on the appropriate management of antibiotic therapies.

Cited by 366 publications

References 126 publications

Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Atypical Findings on Magnetic Resonance Imaging in the Patients with Active Pyogenic Spondylitis in Japanese University Hospitals

Relationship between antibiotic consumption, oropharyngeal colonization, and ventilator-associated pneumonia by Staphylococcus aureus in an intensive care unit of a Brazilian teaching hospital

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