Impact of an enhanced antibiotic stewardship on reducing methicillin-resistant Staphylococcus aureus in primary and secondary healthcare settings

M.A. Aldeyab, M.G. Scott, M.P. Kearney, Y.M. Alahmadi, F.A. Magee, G. Conlon, J.C. McElnay

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20 Citations (Scopus)


The objective of this study was to evaluate the impact of restricting high-risk antibiotics on methicillin-resistant Staphylococcus aureus (MRSA) incidence rates in a hospital setting. A secondary objective was to assess the impact of reducing fluoroquinolone use in the primary-care setting on MRSA incidence in the community. This was an interventional, retrospective, ecological investigation in both hospital and community (January 2006 to June 2010). Segmented regression analysis of interrupted time-series was employed to evaluate the intervention. The restriction of high-risk antibiotics was associated with a significant change in hospital MRSA incidence trend (coefficient=-0·00561, P=0·0057). Analysis showed that the intervention relating to reducing fluoroquinolone use in the community was associated with a significant trend change in MRSA incidence in community (coefficient=-0·00004, P=0·0299). The reduction in high-risk antibiotic use and fluoroquinolone use contributed to both a reduction in incidence rates of MRSA in hospital and community (primary-care) settings. © 2013 Cambridge University Press.
Original languageEnglish
Pages (from-to)494-500
Number of pages7
JournalEpidemiology and Infection
Issue number3
Early online date5 Jun 2013
Publication statusPublished (in print/issue) - 2014

Bibliographical note

Cited By :7

Export Date: 15 September 2018


Correspondence Address: Aldeyab, M.A.; Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, Northern Ireland, United Kingdom; email:

Chemicals/CAS: amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; clindamycin, 18323-44-9

References: Lindsay, J.A., Holden, M.T., Staphylococcus aureus: Superbug, super genome? (2004) Trends in Microbiology, 12, pp. 378-385; Wilcox, M.H., Dave, J., The cost of hospital-acquired infection and the value of infection control (2000) Journal of Hospital Infection, 45, pp. 81-84; Gould, I.M., The clinical significance of methicillinresistant Staphylococcus aureus (2005) Journal of Hospital Infection, 61, pp. 277-282; Deleo, F.R., Community-associated meticillinresistant Staphylococcus aureus (2010) Lancet, 375, pp. 1557-1568; Coia, J.E., Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities (2006) Journal of Hospital Infection, 63 (SUPPL. 1), pp. S1-44; Aldeyab, M.A., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis (2008) Journal of Antimicrobial Chemotherapy, 62, pp. 593-600; Stefani, S., Goglio, A., Methicillin-resistant Staphylococcus aureus: Related infections and antibiotic resistance (2010) International Journal of Infectious Diseases, 14 (SUPPL. 4), pp. S19-22; Byrne, F.M., Wilcox, M.H., MRSA prevention strategies and current guidelines (2011) Injury, 42 (SUPPL. 5), pp. S3-6; Davey, P., Interventions to improve antibiotic prescribing practices for hospital inpatients (2005) Cochrane Database OfSystematicReviews, , Issue 4,Art.No.CD003543; Dellit, T.H., Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship (2007) Clinical Infectious Diseases, 44, pp. 159-177; Aldeyab, M.A., Multihospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures (2011) Infection Control and Hospital Epidemiology, 32, pp. 210-219; Aldeyab, M.A., An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings (2012) Journal of Antimicrobial Chemotherapy, 67, pp. 2988-2996; Aldeyab, M.A., The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings (2012) British Journal of Clinical Pharmacology, 74, pp. 171-179; (2012) Guidelines for ATC Classification and DDD Assignment, , WHO Collaborating Centre for Drug Statistics Methodology Oslo, 2011; Tobacman, J.K., Assessment of comorbidity: A review (1994) Clinical Performance and Quality Health Care, 2, pp. 23-32; Conlon, G., Improving and maintaining adherence with hospital antibiotic policies: A strategy for success (2011) Journal of Hospital Infection, 77, pp. 88-89; Wagner, A.K., Segmented regression analysis of interrupted time series studies in medication use research (2002) Journal of Clinical Pharmacy and Therapeutics, 27, pp. 299-309; Tacconelli, E., Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and metaanalysis (2008) Journal of Antimicrobial Chemotherapy, 61, pp. 26-38; Vernaz, N., Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile (2008) Journal of Antimicrobial Chemotherapy, 62, pp. 601-607; Kaier, K., Two time-series analyses of the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection (2009) Infection Control and Hospital Epidemiology, 30, pp. 346-353; Parienti, J.J., Hospital-wide modification of fluoroquinolone policy and meticillin-resistant Staphylococcus aureus rates: A 10-year interrupted time-series analysis (2011) Journal of Hospital Infection, 78, pp. 118-122; Lafaurie, M., Reduction of fluoroquinolone use is associated with a decrease in methicillin-resistant Staphylococcus aureus and fluoroquinolone-resistant Pseudomonas aeruginosa isolation rates: A 10 year study (2012) Journal of Antimicrobial Chemotherapy, 67, pp. 1010-1015; Lipsitch, M., Samore, M.H., Antimicrobial use and antimicrobial resistance: A population perspective (2002) Emerging Infectious Diseases, 8, pp. 347-354; Hoiby, N., Excretion of ciprofloxacin in sweat and multiresistant Staphylococcus epidermidis (1997) Lancet, 349, pp. 167-169; Costelloe, C., Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis (2010) British Medical Journal, 340, pp. c2096; Costelloe, C., Effect of antibiotic prescribing in primary care on meticillin-resistant Staphylococcus aureus carriage in community-resident adults: A controlled observational study (2012) International Journal of Antimicrobial Agents, 39, pp. 135-141; Sroka, S., Gastmeier, P., Meyer, E., Impact of alcohol hand-rub use on meticillin-resistant Staphylococcus aureus: An analysis of the literature (2010) Journal of Hospital Infection, 74, pp. 204-211; Jarlier, V., Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program (2010) Archives of Internal Medicine, 170, pp. 552-559; Harris, A.D., Lautenbach, E., Perencevich, E., A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance (2005) Clinical Infectious Diseases, 41, pp. 77-82; Muller, A., Effect of individual- and group-level antibiotic exposure on MRSA isolation: A multilevel analysis (2006) Journal of Antimicrobial Chemotherapy, 58, pp. 878-881


  • Antibiotic stewardship
  • Fluoroquinolones
  • Interrupted-time series
  • Methicillin-resistant Staphylococcus aureus
  • Primary and secondary care
  • amoxicillin plus clavulanic acid
  • antibiotic agent
  • cephalosporin derivative
  • clindamycin
  • macrolide
  • quinoline derived antiinfective agent
  • quinolone derivative
  • antibiotic stewardship
  • antibiotic therapy
  • article
  • clinical effectiveness
  • community assessment
  • drug use
  • ecosystem monitoring
  • health program
  • hospital
  • hospital policy
  • human
  • incidence
  • intervention study
  • methicillin resistant Staphylococcus aureus
  • outcome assessment
  • primary health care
  • protocol compliance
  • regression analysis
  • retrospective study
  • secondary health care
  • therapy delay
  • time series analysis
  • treatment outcome
  • trend study
  • antibiotic resistance
  • Article
  • bacterium identification
  • community care
  • controlled study
  • health care policy
  • health impact assessment
  • high risk population
  • nonhuman
  • risk assessment
  • risk factor
  • risk reduction
  • Anti-Bacterial Agents
  • Cephalosporins
  • Clindamycin
  • Cross Infection
  • Drug Utilization
  • Humans
  • Incidence
  • Intervention Studies
  • Methicillin-Resistant Staphylococcus aureus
  • Northern Ireland
  • Primary Health Care
  • Retrospective Studies
  • Staphylococcal Infections


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