Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: a quasi experimental study.
BACKGROUND
We investigated the possible association between fluoroquinolone use and the rate of methicillin-resistant Staphylococcus aureus (MRSA) recovery from consecutive hospitalized patients.


METHODS
We conducted a nonrandomized, prospective, controlled interventional "fluoroquinolone-free" study at 4 large teaching hospitals in northwest France, catering to a total of 5,882,600 persons. During the intervention period (January through December 2001), fluoroquinolone use was prohibited at 1 of the 4 hospitals (Caen Hospital), unless no effective alternative was available. Three university hospitals were used as controls because they had similar preintervention rates of MRSA.


RESULTS
During the intervention period (2001), the annual rate of fluoroquinolone use decreased from 54 to 5 defined daily doses per 1000 patients per day at Caen Hospital and remained stable in the control hospitals. At the end of the intervention, the rate of MRSA isolation was significantly lower at Caen Hospital than at the control hospitals (353 [32.3%] of 1093 S. aureus isolates were MRSA, compared with 2495 [36.8%] of 6787 isolates; odds ratio, 0.82; 95% confidence interval, 0.69-0.99; P=.036), as determined on the basis of a marginal model that took into account within-hospital clustering. In a before-after time series analysis, compared with forecasted rates, there was a significant downward trend in observed monthly rates of MRSA isolation at Caen Hospital at the end of the intervention.


CONCLUSIONS
This quasi experimental study confirms the association between fluoroquinolone use and MRSA isolation among hospitalized patients.
Department of Medical Intensive Care Unit, Côte de Nacre University Hospital, Caen, France. charbonneau-p@chu-caen.fr
Pierre
P
Charbonneau
Jean-Jacques
JJ
Parienti
Pascal
P
Thibon
Michel
M
Ramakers
Cédric
C
Daubin
Damien
D
du Cheyron
Guy
G
Lebouvier
Xavier
X
Le Coutour
Roland
R
Leclercq
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D024841:Fluoroquinolones / Q000008:administration & dosage* / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones