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Evaluation of an Intervention Designed to Decrease the Rate of Nosocomial Methicillin-Resistant Staphylococcus aureus Infection by Encouraging Decreased Fluoroquinolone Use

Published online by Cambridge University Press:  21 June 2016

Karl J. Madaras-Kelly ,
Richard E. Remington ,
Pamela G. Lewis  and
Dennis L. Stevens
Karl J. Madaras-Kelly*
Affiliation:
Clinical Pharmacy Service, Boise Veterans Affairs Medical Center, and theCollege of Pharmacy, Idaho State University, Boise, Idaho
Richard E. Remington
Affiliation:
College of Health Sciences, Boise State University, Boise, Idaho
Pamela G. Lewis
Affiliation:
Veterans Affairs Infectious Diseases Service, Boise, Idaho
Dennis L. Stevens
Affiliation:
Veterans Affairs Infectious Diseases Service, Boise, Idaho School of Medicine, University of Washington, Seattle
*
ISU College of Pharmacy, c/o Boise VA Medical Center, 500 West Fort Street (119A), Boise, ID 83702 (KMK@otc.isu.edu)
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Abstract

Objective.

Society for Health Care Epidemiology guidelines recommend decreasing the use of fluoroquinolone antibiotics in institutions where methicillin-resistant Staphylococcus aureus (MRSA) is endemic. We evaluated whether an intervention to limit fluoroquinolone use was associated with a lower rate of nosocomial MRSA infection and summarized changes in antibiotic use, changes in other variables potentially correlated with a lower rate of MRSA infection, and rates of nosocomial infections due to other pathogens.

Design.

Single-center quasi-experimental design. A time series of nosocomial MRSA infections was measured at monthly intervals from July 2001 through June of 2004; there were 80 MRSA infections recorded. Segmented regression analysis (ie, quasi-Poisson generalized linear models) was used to evaluate variables possibly associated with the nosocomial MRSA infection rate.

Setting.

An 87-bed Veterans Affairs teaching hospital with an extended-care facility.

Intervention.

A physician-directed computer-generated intervention designed to limit the use of fluoroquinolone antibiotics was initiated, and institutional changes in antibiotic use and nosocomial MRSA infection rates were tracked.

Results.

After the intervention, fluoroquinolone use decreased by approximately 34%, and levofloxacin use decreased by approximately 50%. Decreased fluoroquinolone use was offset by increased cephalosporin, piperacillin-tazobactam, and trimethoprim-sulfamethoxazole use. The nosocomial MRSA infection rate decreased from 1.37 to 0.63 episodes per 1,000 patient-days after the study intervention (P = .02). Coagulase-negative Staphylococcus and Enterococcus infection rates also decreased. However, the rate of infection with gram-negative organisms increased. The rate of MRSA infection was positively correlated with levofloxacin use (P = .01) and azithromycin use (P = .08), whereas it was negatively correlated with summer season (P = .05). In a subsequent model, the rate of MRSA infection was negatively correlated with the study intervention (P = .04).

Conclusion.

Reduction in the institutional use of fluoroquinolones may be associated with a lower nosocomial MRSA infection rate.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 2 , February 2006 , pp. 155 - 169
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Weber, SG, Gold, HS, Hooper, DC, Karchmer, AW, Carmeli, Y. Fluoroquinolones and the risk of methicillin resistant Staph aureus in hospitalized patients. Emerg Infect Dis 2003; 9:1415–1422.Google Scholar
2.Graffunder, EM, Venezia, RA. Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. J Antimicrob Chemother 2002; 49:999–1005.CrossRefGoogle ScholarPubMed
3.Hori, S, Sunley, R, Tami, A, Grundmann, H. The Nottingham Staphylococcus aureus population study: prevalence of MRSA among the elderly in a university hospital. J Hosp Infect 2002; 50:25–29.Google Scholar
4.Monnet, DL, MacKenzie, FM, Lopez-Lozano, JM, et al. Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000. Emerg Infect Dis 2004; 10:1432–1441.CrossRefGoogle ScholarPubMed
5.Crowcroft, NS, Ronveaux, O, Monnet, DL, Mertens, R. Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals. Infect Control Hosp Epidemiol 1999; 20:31–36.Google Scholar
6.Dziekan, G, Hahn, A, Thune, K. Methicillin-resistant Staphylococccus aureus in a teaching hospital: investigation of nosocomial transmission using a matched case-control study. J Hosp Infect 2000; 46:263–270.Google Scholar
7.Harbarth, S, Liassine, N, Dharan, S, Herrault, P, Auckenthaler, , Pittet, D. Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2000; 31:1380–1385.Google Scholar
8.Manhold, C, von Rolbieki, U, Brase, R, et al. Outbreaks of Staphylococcus aureus infections during treatment of late onset pneumonia with ciprofloxacin in a prospective randomized study. Intensive Care Med 1998; 24:1327–1330.Google Scholar
9.McDonald, LC, Lauderdale, TL, Lo, RJ, Tsai, JJ, Hung, CC. Colonization of HIV infected outpatients in Tiawan with methicillin-resistant and methicillin-susceptible Staphylococcus aureus. Int J STD AIDS 2003; 14: 473–477.CrossRefGoogle Scholar
10.Johnson, CK, Polk, RE, Edmond, M, Wenzel, R. Trends in antimicrobial use from 1999 to 2001 in 36 US hospitals: a SCOPE-MMIT report. In: Program and abstracts of the 42nd Annual Meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy; 2002; San Diego, CA. Abstract K-1005.Google Scholar
11.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003; 24:362–378.Google Scholar
12.Niederman, MS, Mandell, LA, Anzueto, A, et al. The American Thoracic Society. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163:1730–1754.Google Scholar
13.Bartlett, JG, Gorbach, SL. Treatment of aspiration pneumonia and primary lung abscess: penicillin G vs clindamycin. JAMA 1975; 234:935–937.Google Scholar
14.Marik, PE. Aspiration pneumonitis and aspiration pneumonia. New Engl J Med 2001; 344:665–667.Google Scholar
15.Fagon, JY, Chastre, J, Wolff, M, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia: a randomized trial. Ann Intern Med 2000; 132:621–630.CrossRefGoogle ScholarPubMed
16.Chan, R, Hemeryck, L, O'Regan, M, Clancy, L, Feely, J. Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial. BMJ 1995;310:1360–1362.Google Scholar
17.Dewan, NA, Rafique, S, Kanwar, B, et al. Acute exacerbation of COPD: factors associated with poor treatment outcome. Chest 2000; 117:662–671.Google Scholar
18.Baron, TH, Morgan, DE. Acute necrotizing pancreatitis. New Engl J Med 1999; 340:1412–1417.Google Scholar
19.Harris, A, Bradham, D, Baumgartner, M, et al. The use and interpretation of quasi-experimental design in infectious diseases. Clin Infect Dis 2004; 38:1586–1591.Google ScholarPubMed
20.Anon, . National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990–May 1999, issued June 1999. Am J Infect Control 1999; 27:520–532.Google Scholar
21.Hartstein, A, Mullingan, MW. Methicillin. In: Mayall, CG, ed. Resistant Staphylococcus aureus in hospital epidemiology and infection control. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 1999.Google Scholar
22.Cooper, BS, Stone, SP, Kibbler, CC. Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modeling. Health Technology Assessment 2003; 7:1–139.Google Scholar
23.World Health Organization Collaborating Center for Drug Statistics Methodology Web site. Available at: http://www.whocc.no/atcddd/. Accessed August 4, 2004.Google Scholar
24.NCCLS. Performance standards for antimicrobial susceptibility testing. Wayne, PA: NCCLS; 2004. NCCLS document M100-S14.Google Scholar
25.Neter, J, Kutner, MH, Wasserman, W, Nachtsheim, CJ, Neter, J. Applied linear statistical models. 4th ed. New York, NY: McGraw-Hill/Irwin; 1996.Google Scholar
26.McCullagh, P, Neider, JA. Generalized linear models. 2nd ed. Boca Raton, FL: Chapman & Hall/CRC; 1989.CrossRefGoogle Scholar
27.R Development Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. Available at: http://www.r-project.org. Accessed March 10, 2004.Google Scholar
28.Ansari, F, Kirsteen, G, Nathawani, D, et al. Outcome of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. J Antimicrob Chemother 2003; 52:842–848.CrossRefGoogle ScholarPubMed
29.Ramsay, C, Brown, E, Hartman, G, Davey, P. Room for improvement: a systematic review of the quality of evaluations of interventions to improve hospital antibiotic prescribing. J Antimicrob Chemother 2003; 52: 764–771.CrossRefGoogle ScholarPubMed
30.The Cochrane Effective Practice and Organization of Care Group (EPOC). The data collection checklist (2002). Cochrane EPOC methods papers. Available at: http://www.epoc.uottawa.ca/. Accessed November 15, 2003.Google Scholar
31.Farr, BM. Nosocomial infections related to use of intravascular devices inserted for short-term vascular access in hospital epidemiology and infection control. In: Mayall, CG, ed. Resistant Staphylococcus aureus in hospital epidemiology and infection control. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 2003.Google Scholar
32.Mehta, S, Hill, NS. Noninvasive ventilation. Am J Respir Crit Care Med 2001;163:540–577.Google Scholar
33.Davis, KA, Stewart, JJ, Crouch, HK, Florez, CE, Hospenthal, DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004; 39:776–782.Google Scholar
34.Vierti, NJ, Dooley, DP, Davis, CE, Longfield, JN, Meier, PA, Whelen, AC. The effect of moving to a new hospital facility on the prevalence if methicillin resistant Staphylococcus aureus. Am J Infect Control 2004; 32: 262–267.Google Scholar
35.Frank, MO, Battieger, BE, Sorensen, SJ, et al. Decrease in expenditures and select nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clin Perform Qual Health Care 1997; 5:180–188.Google ScholarPubMed
36.Landman, D, Chockalingham, M, Quale, JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae flowing changes in a hospital antibiotic formulary. Clin Infect Dis 1999; 28:1062–1066.Google Scholar
37.May, AK, Melton, SM, McGwin, G, Cross, JM, Mose, SA, Rue, LW. Reduction of vancomycin-resistant enterococcal infections by limitation of broad-spectrum cephalosporin use in a trauma and burn intensive care unit. Shock 2000; 14:259–264.Google Scholar
38.Charbonneau, P, Thibon, JJ, Parienti, MJ, et al. Impact of a 12-month fluoroquinolone restriction on MRSA incidence in a French university hospital. In: Program and abstracts of the 43rd Annual Meeting of the Interscience Conference of Antimicrobial Chemotherapy; 2003; Chicago, IL. Abstract K-1743.Google Scholar
39.Schwaber, MJ, Cosgrove, SE, Gold, H, Kaye, KS, Carmeli, Y. Fluoroquinolones protective against cephalosporin resistance in gram-negative nosocomial pathogens. Emerg Infect Dis 2004; 10:94–99.Google Scholar
40.Bisognano, C, Vaudaux, PE, Lew, DP, Ng, EY, Hooper, DC. Increased expression of fibronectin-binding proteins by fluoroquinolone-resistant Staphylococcus aureus exposed to subinhibitory levels of ciprofloxacin. Antimicrob Agents Chemother 1997; 41:906–913.Google Scholar
41.Evans, ME, Titlow, WB. Levofloxacin selects fluoroquinolone-resistant methicillin-resistant Staphylococcus aureus less frequently than ciprofloxacin. J Antimicrob Chemother 1998; 41:285–288.Google Scholar