Relationship between Spread of Methicillin‐ResistantStaphylococcus aureusand Antimicrobial Use in a French University Hospital

Abstract

The objective of our study was to determine whether antibiotic pressure in the units of a teaching hospital affects the acquisition of methicillin-resistant Staphylococcus aureus (MRSA), independently of the other collective risk factors previously shown to be involved (MRSA colonization pressure, type of hospitalization unit, and care workload). The average incidence of acquisition of MRSA during the 1-year study period was 0.31 cases per 1000 days of hospitalization, and the use of ineffective antimicrobials reached 504.54 daily defined doses (DDDs) per 1000 days of hospitalization. Univariate analysis showed that acquisition of MRSA was significantly correlated with the use of all antimicrobials, as well as correlated with the use of each class of antimicrobial and with colonization pressure. Multivariate analysis with a Poisson regression model showed that the use of antimicrobials was associated with the incidence of acquisition of MRSA, independently of the other variables studied, but it did not allow us to determine the hierarchy of the different antimicrobial classes with respect to the effect.

Clinical impact of MRSA in a stem cell transplant unit: analysis before, during and after an MRSA outbreak

“…In addition, the use of prophylactic ciprofloxacin on the non-transplant ward was suspended as the strains seen were universally resistant and ciprofloxacin is known to select for, and prolong the carriage of, MRSA. [11][12][13] A striking feature in these patients is the very high incidence of invasive MRSA infections, which has not been previously reported. This was particularly noted in, but not confined to, the outbreak period.…”

Uso racional de antimicrobianos en el departamento de medicina interna de un hospital universitario: resultados de una experiencia piloto

“…Existe una relación bien establecida entre el uso de determinados antimicrobianos (cefalosporinas de tercera generación y quinolonas) con la mayor incidencia de resistencia de algunos microorganismos (BGN productores de ß-lactamasas de espectro extendido, BGN no fermentadores multi-resistentes), así como las políticas que implican restricción de estos antimicrobianos tienen un impacto positivo tanto sobre la colonización como la infección por estos microorganismos 4,5,10,19,21,22 . También se ha reportado una menor incidencia de diarreas por Clostridium diffi cile como resultado de la implementación de estrategias de uso apropiado de antimicrobianos, con restricción del uso de cefalosporinas y clindamicina 14,16 .…”

“…El uso excesivo o inapropiado de estos agentes es uno de los factores que contribuye al desarrollo y selección de cepas bacterianas resistentes [3][4][5] . Se ha demostrado que estas cepas son responsables de mayor morbilidad, mortalidad, estadía hospitalaria y costos asociados [6][7][8][9][10] .…”

Health-Related Quality of Life after Intensive Care Unit Discharge: A Comparison between 2 Standard Antibiotic Regimens

“…3 Subsequently, a significant amount of research was carried out in an attempt to explore the relationship between antibiotic use and acquisition of methicillin-resistant Staphylococcus aureus (MRSA). [4][5][6] Given the fact that the risk of MRSA acquisition is thought to be modulated by the use of particular antimicrobial therapies, 4 " 6 a comprehensive investigation was undertaken with the aim of evaluating the impact of using either ciprofloxacin or tazocin (piperacillin plus tazobactam) on the incidence of MRSA infection in an ICU. 7 To supplement the findings of this published work and to consider the impact of infection on health-related quality of life of hospitalized patients after discharge, patients were assessed using the EQ-5D questionnaire.…”

“…A similar pattern has been reported elsewhere (ie, a decade of infection control with ADI followed by increasingly higher rates of HAI due to the increasingly more frequent admission of patients colonized with healthcareassociated strains of MRSA). 4 7. When the University of Virginia began testing all nonisolated, transferred patients, increasing rates of unrecognized MRSA and VRE colonization were documented among surrounding healthcare facilities-mostly small hospitals and nursing homes.…”