Effect of individual- and group-level antibiotic exposure on MRSA isolation: a multilevel analysis.
OBJECTIVE
To observe the relative role of individual and group-level antimicrobial selective pressure on subsequent methicillin-resistant Staphylococcus aureus (MRSA) isolation in a university hospital.


METHODS
For this purpose, 18 596 patients were included in a retrospective statistical analysis, applying multilevel modelling with discrete time intervals at the lowest level. Individual-level and hospital group variables on antimicrobial exposure and MRSA colonization pressure were collected from computerized databases.


RESULTS
The simultaneous hospital group- and individual-level analysis showed individual exposure to fluoroquinolones and collective exposure to penicillins to be associated with MRSA isolation after adjustment for colonization pressure and other potential confounders.


CONCLUSIONS
These results support efforts to reduce prescriptions of selected antimicrobial drug classes such as fluoroquinolones and show the added value of multilevel analysis for research on the adverse outcomes of antibiotic prescribing.
Muller
Arno
A
Service d'Hygiène Hospitalière et d'Epidémiologie moléculaire, Centre Hospitalier Universitaire Jean Minjoz, 25030 Besançon, France.
Mauny
Frédéric
F
Talon
Daniel
D
Donnan
Peter T
PT
Harbarth
Stephan
S
Bertrand
Xavier
X
D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology / Q000627:therapeutic use; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D008954:Models, Biological; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D010406:Penicillins