Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis

M.A. Aldeyab, D.I. Monnet, J.M. López-Lozano, C.M. Hughes, M.G. Scott, M.P. Kearney, F.A. Magee, J.C. Mcelnay

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. A wide range of factors have been suggested to influence the spread of MRSA. The objective of this study was to evaluate the effect of antimicrobial drug use and infection control practices on nosocomial MRSA incidence in a 426-bed general teaching hospital in Northern Ireland. Methods: The present research involved the retrospective collection of monthly data on the usage of antibiotics and on infection control practices within the hospital over a 5 year period (January 2000-December 2004). A multivariate ARIMA (time-series analysis) model was built to relate MRSA incidence with antibiotic use and infection control practices. Results: Analysis of the 5 year data set showed that temporal variations in MRSA incidence followed temporal variations in the use of fluoroquinolones, third-generation cephalosporins, macrolides and amoxicillin/clavulanic acid (coefficients = 0.005, 0.03, 0.002 and 0.003, respectively, with various time lags). Temporal relationships were also observed between MRSA incidence and infection control practices, i.e. the number of patients actively screened for MRSA (coefficient = -0.007), the use of alcohol-impregnated wipes (coefficient = -0.0003) and the bulk orders of alcohol-based handrub (coefficients = -0.04 and -0.08), with increased infection control activity being associated with decreased MRSA incidence, and between MRSA incidence and the number of new patients admitted with MRSA (coefficient = 0.22). The model explained 78.4% of the variance in the monthly incidence of MRSA. Conclusions: The results of this study confirm the value of infection control policies as well as suggest the usefulness of restricting the use of certain antimicrobial classes to control MRSA. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
LanguageEnglish
Pages593-600
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume62
Issue number3
Early online date7 May 2008
DOIs
Publication statusPublished - 1 Sep 2008

Fingerprint

Methicillin-Resistant Staphylococcus aureus
Infection Control
Anti-Bacterial Agents
Incidence
Alcohols
Amoxicillin-Potassium Clavulanate Combination
Northern Ireland
Drug and Narcotic Control
Fluoroquinolones
Macrolides
Cephalosporins
Teaching Hospitals
General Hospitals
Drug Therapy

Keywords

  • Antibiotic resistance
  • Hospital-acquired MRSA
  • S. aureus
  • alcohol
  • aminoglycoside antibiotic agent
  • amoxicillin plus clavulanic acid
  • antibiotic agent
  • antiinfective agent
  • beta lactamase inhibitor
  • carbapenem derivative
  • cephalosporin derivative
  • chloramphenicol derivative
  • chlorhexidine
  • imidazole derivative
  • lincosamide derivative
  • macrolide
  • nitrofuran derivative
  • penicillin derivative
  • polypeptide antibiotic agent
  • pseudomonic acid
  • quinoline derived antiinfective agent
  • steroid
  • sulfonamide
  • tetracycline derivative
  • trimethoprim derivative
  • adolescent
  • adult
  • aged
  • antibiotic resistance
  • antibiotic sensitivity
  • article
  • bacterial infection
  • child
  • drug use
  • female
  • hospital
  • hospital admission
  • hospital bed capacity
  • human
  • incidence
  • infant
  • infection control
  • Ireland
  • major clinical study
  • male
  • methicillin resistant Staphylococcus aureus
  • nonhuman
  • screening
  • teaching hospital
  • time series analysis
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents
  • Child
  • Child, Preschool
  • Cross Infection
  • Drug Utilization
  • Female
  • Hospitals, Teaching
  • Humans
  • Incidence
  • Infant
  • Infection Control
  • Male
  • Methicillin Resistance
  • Middle Aged
  • Multivariate Analysis
  • Northern Ireland
  • Retrospective Studies
  • Staphylococcal Infections
  • Staphylococcus aureus
  • Statistics as Topic
  • Time Factors

Cite this

Aldeyab, M.A. ; Monnet, D.I. ; López-Lozano, J.M. ; Hughes, C.M. ; Scott, M.G. ; Kearney, M.P. ; Magee, F.A. ; Mcelnay, J.C. / Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis. In: Journal of Antimicrobial Chemotherapy. 2008 ; Vol. 62, No. 3. pp. 593-600.
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abstract = "Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. A wide range of factors have been suggested to influence the spread of MRSA. The objective of this study was to evaluate the effect of antimicrobial drug use and infection control practices on nosocomial MRSA incidence in a 426-bed general teaching hospital in Northern Ireland. Methods: The present research involved the retrospective collection of monthly data on the usage of antibiotics and on infection control practices within the hospital over a 5 year period (January 2000-December 2004). A multivariate ARIMA (time-series analysis) model was built to relate MRSA incidence with antibiotic use and infection control practices. Results: Analysis of the 5 year data set showed that temporal variations in MRSA incidence followed temporal variations in the use of fluoroquinolones, third-generation cephalosporins, macrolides and amoxicillin/clavulanic acid (coefficients = 0.005, 0.03, 0.002 and 0.003, respectively, with various time lags). Temporal relationships were also observed between MRSA incidence and infection control practices, i.e. the number of patients actively screened for MRSA (coefficient = -0.007), the use of alcohol-impregnated wipes (coefficient = -0.0003) and the bulk orders of alcohol-based handrub (coefficients = -0.04 and -0.08), with increased infection control activity being associated with decreased MRSA incidence, and between MRSA incidence and the number of new patients admitted with MRSA (coefficient = 0.22). The model explained 78.4{\%} of the variance in the monthly incidence of MRSA. Conclusions: The results of this study confirm the value of infection control policies as well as suggest the usefulness of restricting the use of certain antimicrobial classes to control MRSA. {\circledC} The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.",
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author = "M.A. Aldeyab and D.I. Monnet and J.M. L{\'o}pez-Lozano and C.M. Hughes and M.G. Scott and M.P. Kearney and F.A. Magee and J.C. Mcelnay",
note = "Cited By :92 Export Date: 15 September 2018 CODEN: JACHD Correspondence Address: Mcelnay, J.C.; Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom; email: j.mcelnay@qub.ac.uk Chemicals/CAS: alcohol, 64-17-5; amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; chlorhexidine, 3697-42-5, 55-56-1; pseudomonic acid, 12650-69-0, 40980-51-6, 71980-98-8; Anti-Bacterial Agents References: Johnson, A.P., Pearson, A., Duckworth, G., Surveillance and epidemiology of MRSA bacteraemia in the UK (2005) J Antimicrob Chemother, 56, pp. 455-462; Muto, C.A., Jemigan, J.A., Ostrowsky, B.E., SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus (2003) Infect Control Hosp Epidemiol, 24, pp. 362-386; Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals (1998) J Hosp Infect, 39, pp. 253-290. , British Society for Antimicrobial Chemotherapy, Hospital Infection Society and the Infection Control Nurses Association; Gamer, J.S., Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals (1996) Infect Control Hosp Epidemiol, 17, pp. 53-80; Cooper, B.S., Stone, S.P., Kibbler, C.C., Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): Systematic review of the literature (2004) Br Med J, 329, p. 533; National nosocomial infection surveillance systems report, data summary from January 1992-June 2001, issued August 2001 (2002) Am J Infect Control, 30, pp. 458-475. , Centers for Disease Control Prevention; Muller, A.A., Mauny, F., Bertin, M., Relationship between spread of methicillin-resistant Staphylococcus aureus and antimicrobial use in a French university hospital (2003) Clin Infect Dis, 36, pp. 971-978; Monnet, D.L., Mackenzie, F.M., L{\'o}pez-Lozano, J.M., Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000 (2004) Emerg Infect Dis, 10, pp. 1432-1441; Aubert, G., Carricago, A., Vautrin, C.A., Impact of restricting fluoroquinolone prescription on bacterial resistance in an intensive care unit (2005) J Hosp Infect, 59, pp. 83-89; Wilcox, M.H., Antibiotic prescribing as a risk factor for MRSA (2005) Hosp Med, 66, pp. 180-184; (1996) Stat Methods Med Res, 5, pp. 3-22. , Helfenstein U. Box-Jenkins modelling in medical research; L{\'o}pez-Lozano, J.M., Monnet, D.L., Yague, A., Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: A time series analysis (2000) Int J Antimicrob Agents, 14, pp. 21-31; Comaglia, G., Hryniewicz, W., Jarlier, V., European recommendations for antimicrobial resistance surveillance (2005) Clin Microbiol Infect, 10, pp. 349-383; (2002) Guidelines for ATC classifications and DDDs assignment, , WHO Collaborating Centre for Drug Statistics Methodology, Oslo, Norway: WHO Collaborating Centre; Pankratz, A., (1991) Forecasting with Dynamic Regression Models, , New York: Wiley; Mahamat, A., Mackenzie, F.M., Brooker, K., Impact of infection control interventions and antibiotic use on hospital MRSA: A multi-variate interrupted time-series analysis (2007) Int J Antimicrob Agents, 30, pp. 169-176; Aldeyab, M., Hughes, C.M., Scott, M.G., The role of antibiotics in the development of methicillin-resistant Staphylococcus aureus (MRSA) (2005) Int J Pharm Pract, 13 (SUPPL. R92); Crowcroft, N.S., Ronveaux, O., Monnet, D.L., Methicillin-resistant Staphyloccus aureus and antimicrobial use in Belgian hospitals (1999) Infect Control Hosp Epidemiol, 20, pp. 31-36; Weber, S.G., Gold, H.S., Hooper, D.C., Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients (2003) Emerg Infect Dis, 9, pp. 1415-1422; Charbonneau, P., Parienti, J.J., Thibon, P., Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: A quasi experimental study (2006) Clin Infect Dis, 42, pp. 778-784; Muller, A., Mauny, F., Talon, D., Effect of individual- and group-level antibiotic exposure on MRSA isolation: A multilevel analysis (2006) J Antimicrob Chemother, 58, pp. 878-881; McGowan Jr., J.E., Antimicrobial resistance in hospital organisms and its relation to antibiotic use (1983) Rev Infect Dis, 5, pp. 1033-1048; Tacconelli, E., De Angelis, G., Cataldo, M.A., Does antibiotic exposure increase the risk of methicilin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis (2008) J Antimicrob Chemother, 61, pp. 26-38; Cunningham, R., Jenks, P., Northwood, J., Effect on MRSA transmission of rapid PCR testing of patients admitted to critical care (2007) J Hosp Infect, 65, pp. 24-28; Lucet, J.C., Paoletti, X., Lolom, I., Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units (2005) Intensive Care Med, 31, pp. 1051-1057; Rubinovitch, B., Pittet, D., Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: What have we learned? (2001) J Hosp Infect, 47, pp. 9-18; Farr, B.M., Jarvis, W.R., Would active surveillance cultures help control healthcare-related methicillin-resistant Staphylococcus aureus infections? (2002) Infect Control Hosp Epidemiol, 23, pp. 65-68; Francois, P., Pittet, D., Bento, M., Rapid detection of methicillin-resistant Staphylococcus aureus directly from sterile or non-sterile clinical samples by a new molecular assay (2003) J Clin Microbiol, 41, pp. 254-260; Widmer, A.F., Replace hand washing with use of a waterless alcohol hand rub? (2000) Clin Infect Dis, 31, pp. 136-143; Pittet, D., Hugonnet, S., Harbarth, S., Effectiveness of a hospital-wide programme to improve compliance with hand hygiene: Infection control programme (2000) Lancet, 356, pp. 1307-1312; Johnson, P.D., Martin, R., Burrell, L.J., Efficacy of an alcohol/ chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection (2005) Med J Aust, 183, pp. 509-514; Graham, M., Nixon, R., Burrell, L.J., Low rates of cutaneous adverse reactions to alcohol-based hand hygiene solution during prolonged use in a large teaching hospital (2005) Antimicrob Agents Chemother, 49, pp. 4404-4405; Gordin, F.M., Schultz, M.E., Huber, R.A., Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub (2005) Infect Control Hosp Epidemiol, 26, pp. 650-653; Sexton, T., Clarke, P., O'Neill, E., Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: Correlation with patient isolates and implications for hospital hygiene (2006) J Hosp Infect, 62, pp. 187-194; Hill, C., King, T., Day, R., A strategy to reduce MRSA colonization of stethoscopes (2005) J Hosp Infect, 62, pp. 122-123; Dancer, S.J., Coyne, M., Speekenbrink, A., MRSA acquisition in an intensive care unit (2006) Am J Infect Control, 34, pp. 10-17; Madaras-Kelly, K.J., Remington, R.E., Lewis, P.G., Evaluation of an intervention designed to decrease the rate of nosocomial methicillin-resistant Staphylococcus aureus infection by encouraging decreased fluoroquinolone use (2006) Infect Control Hosp Epidemiol, 27, pp. 155-169; Apisamthanarak, A., Danchaivijitr, S., Khawcharoenpom, T., Effectiveness of education and an antibiotic-control program in a tertiary care hospital in Thailand (2006) Clin Infect Dis, 42, pp. 768-775; Brown, E.M., Nathwani, D., Antibiotic cycling or rotation: A systematic review of the evidence of efficacy (2005) J Antimicrob Chemother, 55, pp. 6-9",
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Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis. / Aldeyab, M.A.; Monnet, D.I.; López-Lozano, J.M.; Hughes, C.M.; Scott, M.G.; Kearney, M.P.; Magee, F.A.; Mcelnay, J.C.

In: Journal of Antimicrobial Chemotherapy, Vol. 62, No. 3, 01.09.2008, p. 593-600.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis

AU - Aldeyab, M.A.

AU - Monnet, D.I.

AU - López-Lozano, J.M.

AU - Hughes, C.M.

AU - Scott, M.G.

AU - Kearney, M.P.

AU - Magee, F.A.

AU - Mcelnay, J.C.

N1 - Cited By :92 Export Date: 15 September 2018 CODEN: JACHD Correspondence Address: Mcelnay, J.C.; Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom; email: j.mcelnay@qub.ac.uk Chemicals/CAS: alcohol, 64-17-5; amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; chlorhexidine, 3697-42-5, 55-56-1; pseudomonic acid, 12650-69-0, 40980-51-6, 71980-98-8; Anti-Bacterial Agents References: Johnson, A.P., Pearson, A., Duckworth, G., Surveillance and epidemiology of MRSA bacteraemia in the UK (2005) J Antimicrob Chemother, 56, pp. 455-462; Muto, C.A., Jemigan, J.A., Ostrowsky, B.E., SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus (2003) Infect Control Hosp Epidemiol, 24, pp. 362-386; Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals (1998) J Hosp Infect, 39, pp. 253-290. , British Society for Antimicrobial Chemotherapy, Hospital Infection Society and the Infection Control Nurses Association; Gamer, J.S., Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals (1996) Infect Control Hosp Epidemiol, 17, pp. 53-80; Cooper, B.S., Stone, S.P., Kibbler, C.C., Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): Systematic review of the literature (2004) Br Med J, 329, p. 533; National nosocomial infection surveillance systems report, data summary from January 1992-June 2001, issued August 2001 (2002) Am J Infect Control, 30, pp. 458-475. , Centers for Disease Control Prevention; Muller, A.A., Mauny, F., Bertin, M., Relationship between spread of methicillin-resistant Staphylococcus aureus and antimicrobial use in a French university hospital (2003) Clin Infect Dis, 36, pp. 971-978; Monnet, D.L., Mackenzie, F.M., López-Lozano, J.M., Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000 (2004) Emerg Infect Dis, 10, pp. 1432-1441; Aubert, G., Carricago, A., Vautrin, C.A., Impact of restricting fluoroquinolone prescription on bacterial resistance in an intensive care unit (2005) J Hosp Infect, 59, pp. 83-89; Wilcox, M.H., Antibiotic prescribing as a risk factor for MRSA (2005) Hosp Med, 66, pp. 180-184; (1996) Stat Methods Med Res, 5, pp. 3-22. , Helfenstein U. Box-Jenkins modelling in medical research; López-Lozano, J.M., Monnet, D.L., Yague, A., Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: A time series analysis (2000) Int J Antimicrob Agents, 14, pp. 21-31; Comaglia, G., Hryniewicz, W., Jarlier, V., European recommendations for antimicrobial resistance surveillance (2005) Clin Microbiol Infect, 10, pp. 349-383; (2002) Guidelines for ATC classifications and DDDs assignment, , WHO Collaborating Centre for Drug Statistics Methodology, Oslo, Norway: WHO Collaborating Centre; Pankratz, A., (1991) Forecasting with Dynamic Regression Models, , New York: Wiley; Mahamat, A., Mackenzie, F.M., Brooker, K., Impact of infection control interventions and antibiotic use on hospital MRSA: A multi-variate interrupted time-series analysis (2007) Int J Antimicrob Agents, 30, pp. 169-176; Aldeyab, M., Hughes, C.M., Scott, M.G., The role of antibiotics in the development of methicillin-resistant Staphylococcus aureus (MRSA) (2005) Int J Pharm Pract, 13 (SUPPL. R92); Crowcroft, N.S., Ronveaux, O., Monnet, D.L., Methicillin-resistant Staphyloccus aureus and antimicrobial use in Belgian hospitals (1999) Infect Control Hosp Epidemiol, 20, pp. 31-36; Weber, S.G., Gold, H.S., Hooper, D.C., Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients (2003) Emerg Infect Dis, 9, pp. 1415-1422; Charbonneau, P., Parienti, J.J., Thibon, P., Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: A quasi experimental study (2006) Clin Infect Dis, 42, pp. 778-784; Muller, A., Mauny, F., Talon, D., Effect of individual- and group-level antibiotic exposure on MRSA isolation: A multilevel analysis (2006) J Antimicrob Chemother, 58, pp. 878-881; McGowan Jr., J.E., Antimicrobial resistance in hospital organisms and its relation to antibiotic use (1983) Rev Infect Dis, 5, pp. 1033-1048; Tacconelli, E., De Angelis, G., Cataldo, M.A., Does antibiotic exposure increase the risk of methicilin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis (2008) J Antimicrob Chemother, 61, pp. 26-38; Cunningham, R., Jenks, P., Northwood, J., Effect on MRSA transmission of rapid PCR testing of patients admitted to critical care (2007) J Hosp Infect, 65, pp. 24-28; Lucet, J.C., Paoletti, X., Lolom, I., Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units (2005) Intensive Care Med, 31, pp. 1051-1057; Rubinovitch, B., Pittet, D., Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: What have we learned? (2001) J Hosp Infect, 47, pp. 9-18; Farr, B.M., Jarvis, W.R., Would active surveillance cultures help control healthcare-related methicillin-resistant Staphylococcus aureus infections? (2002) Infect Control Hosp Epidemiol, 23, pp. 65-68; Francois, P., Pittet, D., Bento, M., Rapid detection of methicillin-resistant Staphylococcus aureus directly from sterile or non-sterile clinical samples by a new molecular assay (2003) J Clin Microbiol, 41, pp. 254-260; Widmer, A.F., Replace hand washing with use of a waterless alcohol hand rub? (2000) Clin Infect Dis, 31, pp. 136-143; Pittet, D., Hugonnet, S., Harbarth, S., Effectiveness of a hospital-wide programme to improve compliance with hand hygiene: Infection control programme (2000) Lancet, 356, pp. 1307-1312; Johnson, P.D., Martin, R., Burrell, L.J., Efficacy of an alcohol/ chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection (2005) Med J Aust, 183, pp. 509-514; Graham, M., Nixon, R., Burrell, L.J., Low rates of cutaneous adverse reactions to alcohol-based hand hygiene solution during prolonged use in a large teaching hospital (2005) Antimicrob Agents Chemother, 49, pp. 4404-4405; Gordin, F.M., Schultz, M.E., Huber, R.A., Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub (2005) Infect Control Hosp Epidemiol, 26, pp. 650-653; Sexton, T., Clarke, P., O'Neill, E., Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: Correlation with patient isolates and implications for hospital hygiene (2006) J Hosp Infect, 62, pp. 187-194; Hill, C., King, T., Day, R., A strategy to reduce MRSA colonization of stethoscopes (2005) J Hosp Infect, 62, pp. 122-123; Dancer, S.J., Coyne, M., Speekenbrink, A., MRSA acquisition in an intensive care unit (2006) Am J Infect Control, 34, pp. 10-17; Madaras-Kelly, K.J., Remington, R.E., Lewis, P.G., Evaluation of an intervention designed to decrease the rate of nosocomial methicillin-resistant Staphylococcus aureus infection by encouraging decreased fluoroquinolone use (2006) Infect Control Hosp Epidemiol, 27, pp. 155-169; Apisamthanarak, A., Danchaivijitr, S., Khawcharoenpom, T., Effectiveness of education and an antibiotic-control program in a tertiary care hospital in Thailand (2006) Clin Infect Dis, 42, pp. 768-775; Brown, E.M., Nathwani, D., Antibiotic cycling or rotation: A systematic review of the evidence of efficacy (2005) J Antimicrob Chemother, 55, pp. 6-9

PY - 2008/9/1

Y1 - 2008/9/1

N2 - Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. A wide range of factors have been suggested to influence the spread of MRSA. The objective of this study was to evaluate the effect of antimicrobial drug use and infection control practices on nosocomial MRSA incidence in a 426-bed general teaching hospital in Northern Ireland. Methods: The present research involved the retrospective collection of monthly data on the usage of antibiotics and on infection control practices within the hospital over a 5 year period (January 2000-December 2004). A multivariate ARIMA (time-series analysis) model was built to relate MRSA incidence with antibiotic use and infection control practices. Results: Analysis of the 5 year data set showed that temporal variations in MRSA incidence followed temporal variations in the use of fluoroquinolones, third-generation cephalosporins, macrolides and amoxicillin/clavulanic acid (coefficients = 0.005, 0.03, 0.002 and 0.003, respectively, with various time lags). Temporal relationships were also observed between MRSA incidence and infection control practices, i.e. the number of patients actively screened for MRSA (coefficient = -0.007), the use of alcohol-impregnated wipes (coefficient = -0.0003) and the bulk orders of alcohol-based handrub (coefficients = -0.04 and -0.08), with increased infection control activity being associated with decreased MRSA incidence, and between MRSA incidence and the number of new patients admitted with MRSA (coefficient = 0.22). The model explained 78.4% of the variance in the monthly incidence of MRSA. Conclusions: The results of this study confirm the value of infection control policies as well as suggest the usefulness of restricting the use of certain antimicrobial classes to control MRSA. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

AB - Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. A wide range of factors have been suggested to influence the spread of MRSA. The objective of this study was to evaluate the effect of antimicrobial drug use and infection control practices on nosocomial MRSA incidence in a 426-bed general teaching hospital in Northern Ireland. Methods: The present research involved the retrospective collection of monthly data on the usage of antibiotics and on infection control practices within the hospital over a 5 year period (January 2000-December 2004). A multivariate ARIMA (time-series analysis) model was built to relate MRSA incidence with antibiotic use and infection control practices. Results: Analysis of the 5 year data set showed that temporal variations in MRSA incidence followed temporal variations in the use of fluoroquinolones, third-generation cephalosporins, macrolides and amoxicillin/clavulanic acid (coefficients = 0.005, 0.03, 0.002 and 0.003, respectively, with various time lags). Temporal relationships were also observed between MRSA incidence and infection control practices, i.e. the number of patients actively screened for MRSA (coefficient = -0.007), the use of alcohol-impregnated wipes (coefficient = -0.0003) and the bulk orders of alcohol-based handrub (coefficients = -0.04 and -0.08), with increased infection control activity being associated with decreased MRSA incidence, and between MRSA incidence and the number of new patients admitted with MRSA (coefficient = 0.22). The model explained 78.4% of the variance in the monthly incidence of MRSA. Conclusions: The results of this study confirm the value of infection control policies as well as suggest the usefulness of restricting the use of certain antimicrobial classes to control MRSA. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

KW - Antibiotic resistance

KW - Hospital-acquired MRSA

KW - S. aureus

KW - alcohol

KW - aminoglycoside antibiotic agent

KW - amoxicillin plus clavulanic acid

KW - antibiotic agent

KW - antiinfective agent

KW - beta lactamase inhibitor

KW - carbapenem derivative

KW - cephalosporin derivative

KW - chloramphenicol derivative

KW - chlorhexidine

KW - imidazole derivative

KW - lincosamide derivative

KW - macrolide

KW - nitrofuran derivative

KW - penicillin derivative

KW - polypeptide antibiotic agent

KW - pseudomonic acid

KW - quinoline derived antiinfective agent

KW - steroid

KW - sulfonamide

KW - tetracycline derivative

KW - trimethoprim derivative

KW - adolescent

KW - adult

KW - aged

KW - antibiotic resistance

KW - antibiotic sensitivity

KW - article

KW - bacterial infection

KW - child

KW - drug use

KW - female

KW - hospital

KW - hospital admission

KW - hospital bed capacity

KW - human

KW - incidence

KW - infant

KW - infection control

KW - Ireland

KW - major clinical study

KW - male

KW - methicillin resistant Staphylococcus aureus

KW - nonhuman

KW - screening

KW - teaching hospital

KW - time series analysis

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anti-Bacterial Agents

KW - Child

KW - Child, Preschool

KW - Cross Infection

KW - Drug Utilization

KW - Female

KW - Hospitals, Teaching

KW - Humans

KW - Incidence

KW - Infant

KW - Infection Control

KW - Male

KW - Methicillin Resistance

KW - Middle Aged

KW - Multivariate Analysis

KW - Northern Ireland

KW - Retrospective Studies

KW - Staphylococcal Infections

KW - Staphylococcus aureus

KW - Statistics as Topic

KW - Time Factors

U2 - 10.1093/jac/dkn198

DO - 10.1093/jac/dkn198

M3 - Article

VL - 62

SP - 593

EP - 600

JO - Journal of Antimicrobial Chemotherapy

T2 - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 3

ER -