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

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115 Citations (Scopus)


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.
Original languageEnglish
Pages (from-to)593-600
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Issue number3
Early online date7 May 2008
Publication statusPublished - 1 Sep 2008


  • 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


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