Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-19T15:16:06.476Z Has data issue: false hasContentIssue false
  • English
  • Français

Methicillin-Resistant Staphylococcus Aureus and Antimicrobial Use in Belgian Hospitals

Published online by Cambridge University Press:  02 January 2015

Natasha S. Crowcroft ,
Olivier Ronveaux ,
Dominique L. Monnet  and
Raf Mertens
Natasha S. Crowcroft
Affiliation:
Epidemiology Department, Scientific Institute of Public Health-Louis Pasteur, Brussels, Belgium
Olivier Ronveaux
Affiliation:
Epidemiology Department, Scientific Institute of Public Health-Louis Pasteur, Brussels, Belgium
Dominique L. Monnet
Affiliation:
National Centre for Hospital Hygiene, Statens Serum Institut, Copenhagen, Denmark
Raf Mertens*
Affiliation:
Epidemiology Department, Scientific Institute of Public Health-Louis Pasteur, Brussels, Belgium
*
Epidemiology Department, Scientific Institute of Public Health-Louis Pasteur, 14 Juliette Wytsmanstraat, Brussels B-1050, Belgium
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate relationships between the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and the use of different classes of antimicrobials in Belgian hospitals.

Design:

Using Pearson correlation coefficients, the number of new nosocomial MRSA-colonized or -infected patients in the second half of 1994 and the first half of 1995 reported by the national MRSA surveillance program was compared with use of various antimicrobial classes as reported by the National Institute for Sickness and Disability Insurance. Relationships between different classes of antimicrobials were evaluated in a correlation matrix. MRSA incidence, antimicrobial use, and potential confounding factors were included in a multiple linear regression analysis.

Setting:

50 hospitals in Belgium.

Results:

The use of a number of different classes of antimicrobials was interrelated. In the multivariate analysis, the incidence of nosocomial MRSA increased with increasing use of ceftazidime and cefsulodin (P=.0003), amoxicillin with clavulanic acid (P=.02), and quinolones (P=.005). No association was found between MRSA incidence and total antimicrobial use.

Conclusions:

The relationships between antimicrobial use and MRSA are complex. Interventions aimed at promoting more rational prescribing patterns should be supported by adequate experimental and epidemiological evidence. Advice for preventing and controlling MRSA has focused mainly on hygienic measures and precautions to avoid cross-transmission; the role of relieving antimicrobial pressure needs to be clarified.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 1 , January 1999 , pp. 31 - 36
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Ayliffe, GAJ. The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1997;24(suppl 1):S74–S79.Google Scholar
2. Cohen, ML. Epidemiology of drug resistance: implications for the post-antimicrobial era. Science 1992;257:1050–1055.Google Scholar
3. McGowan, JE Jr. Antimicrobial resistance in hospitals organisms and its relation to antibiotic use. Rev Infect Dis 1983;5:1033–1048.Google Scholar
4. Shlaes, DM, Gerding, DN, John, JF, Craig, WA, Bornstein, DL, Duncan, RA, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18:275–291.CrossRefGoogle Scholar
5. Ayliffe, GAJ. Recommendations for the control of methicillin-resistant Staphylococcus aureus. Report no. WHO/EMC/LTS/96.1. Geneva, Switzerland: World Health Organization, Division of Emerging and other Communicable Diseases Surveillance and Control; 1996.Google Scholar
6. Patterson, JE. Making sense of MRSA. Lancet 1996;348:836–837.CrossRefGoogle ScholarPubMed
7. Schentag, JJ, Hyatt, JM, Gutfeld, MB, Cumbo, TJ. Improving antibiotic use in health care systems: the role of the clinical pharmacy in an interdisciplinary process. In: Programs and abstracts of the 35th ICAAC; 1995; San Francisco, CA. American Society for Microbiology; 1995:353.Google Scholar
8. Frank, MO, Sorensen, SJ, Carr, JA, McComb, JS, Harstein, AI. Decrease in selected nosocomial infections following implementation of an antimicrobial prescribing improvement program. Infect Control Hosp Epidemiol 1996;17(5, part 2):36.Google Scholar
9. Blumberg, HM, Rimland, D, Carroll, DJ, Terry, P, Wachsmuth, IK. Rapid development of ciprofloxacin resistance in methicillin-susceptible and -resistant Staphylococcus aureus . J Infect Dis 1991;163:1279–1285.CrossRefGoogle ScholarPubMed
10. Witte, W, Braulke, C, Heuck, D, Cuny, C. Analysis of nosocomial outbreaks with multiply and methicillin-resistant Staphylococcus aureus (MRSA) in Germany: implications for hospital hygiene. Infection 1994;22(suppl 2):S128–S134.Google Scholar
11. Nananda, FC, O'Connor, RW. Estimating worldwide current antibiotic use: report of Task Force 1. Rev Infect Dis 1987;9(S3):S232-S43.Google Scholar
12. O'Brien, TF, the members of Task Force 2. Resistance of bacteria to antibacterial agents: report of Task Force 2. Rev Infect Dis 1987;9(3):S244-S60.Google Scholar
13. Archibald, L, Phillips, L, Monnet, D, McGowan, JE Jr, Tenover, F, Gaynes, R. Antimicrobial resistance in isolates from inpatients and outpatients in the United States: increasing importance of the intensive care unit. Clin Infect Dis 1997;24:211–215.Google Scholar
14. Ballow, CH, Schentag, JJ. Trends in antibiotic utilization and bacterial resistance. Report of the National Nosocomial Resistance Surveillance Group. Diagn Microbiol Infect Dis 1992;15:37S–42S.Google Scholar
15. Gerding, DN, Larson, TA. Aminoglycoside resistance in gram-negative bacilli during increased amikacin use. Comparison of experience in 14 United States hospitals with experience in the Minneapolis Veterans' Administration Medical Center. Am J Med 1985;79(suppl 1A):1–7.Google Scholar
16. Monnet, D, Gaynes, R, Tenover, F, McGowan, J, the I-CARE pilot hospitals. Ceftazidime-resistant Pseudomonas aeruginosa (PA) and ceftazidime (CFZ) use in NNIS hospitals: preliminary results of Project I-CARE phase one. Infect Control Hosp Epidemiol 1995;16(4, part 2):19.Google Scholar
17. Muscato, JJ, Wilbur, DW, Stout, JJ, Fahrlender, RA. An evaluation of the susceptibility patterns of gram-negative organisms isolated in cancer centres with aminoglycoside use. Antimicrob Chemother 1991;27:1–7.Google Scholar
18. Staehr Johansen, K, Storgaard, M, Carstensen, N, Hrank, U, Daschner, F. An international study on the occurrence of multiresistant bacteria and aminoglycoside consumption patterns. Infection 1988:16;313–322.Google Scholar
19. Straelens, MJ, Ronveaux, O, Jans, B, Mertens, R, the Groupement pour le Dépistage, l'Etude et la Prévention des Infections Hospitalières. Methicillin-resistant Staphylococcus aureus epidemiology and control in Belgian hospitals, 1991 to 1995. Infect Control Hosp Epidemiol 1996;17:503–508.Google Scholar
20. Straelens, MJ, Mertens, R, the Groupement pour le Dépistage, l'Etude et la Prévention des Infections Hospitalières. National Survey of methicillin-resistant Staphylococcus aureus in Belgian hospitals: detection methods, prevalence trends and infection control measures. Eur J Clin Microbiol Infect Dis 1994;13:56–63.CrossRefGoogle Scholar
21. Voss, A. Milatovic, D, Wallrauch-Schwarz, C, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50–55.Google Scholar
22. Boyce, JM. Patterns of methicillin-resistant Staphylococcus aureus prevalence . Infect Control Hosp Epidemiol 1991;12:79–82.Google Scholar
23. Li, J, Birkhead, GS, Strogatz, DS, Coles, FB. Impact of institution size, staffing patterns and infection control practices on communicable disease outbreaks in New York State nursing homes. Am J Epidemiol 1996;143:1042–1049.Google Scholar
24. Straelens, MJ, Deplano, A, D Ryck, R, Nonhoff, O, Ronveaux, O, Mertens, R. National surveillance of antimicrobial resistance and molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Belgium 1995 versus 1992. Proceedings of the 36th ICAAC; September 15-18, 1995; New Orleans, LA; Washington, DC: American Society for Microbiology; 1996.Google Scholar