title: Impact of limited cephalosporin use on prevalence of methicillin-resistant Staphylococcus aureus in the intensive care unit.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a leading pathogen causing nosocomial infections. Many studies have shown that the restricted use of antibacterials is associated with a decline in resistance. To establish whether an intervention protocol designed to limit the use of cephalosporins can lower mRSA infection rates and impact on Gram-negative bacteria susceptibility in an intensive Care Unit (ICU), we conducted a prospective, non-randomized, before-after intervention study in an 18-bed ICU in Genoa, Italy. The intervention was a hospital antibiotic control policy and the observation was routine monitoring for nosocomial infections and antibiotic use, recording periodically the incidence density and MRSA prevalence. The intervention included a new antibiotic guideline that restricted the use of cephalosporins for all ICU inpatients. The analysis showed that the intervention determined a significant reduction in cephalosporin usage (-70.3%), while fluoroquinolones, mainly ciprofloxacin, increased after introduction of the antibiotic policy (+46.5%). A significant reduction in the percentage of MRSA infections (-30%) and heterogeneous susceptibility patterns in Klebsiella pneumoniae and Pseudomonas aeruginosa were noted.
authors.affiliation: Infectious Diseases Division, S. Martino Hospital and University of Genoa School of Medicine, Genoa, Italy. matteo.bassetti@hsanmartino.it
authors.forename: M
authors.initials: M
authors.lastname: Bassetti
authors.forename: E
authors.initials: E
authors.lastname: Righi
authors.forename: F
authors.initials: F
authors.lastname: Ansaldi
authors.forename: M P
authors.initials: MP
authors.lastname: Molinari
authors.forename: B
authors.initials: B
authors.lastname: Rebesco
authors.forename: J L
authors.initials: JL
authors.lastname: McDermott
authors.forename: R
authors.initials: R
authors.lastname: Fasce
authors.forename: M
authors.initials: M
authors.lastname: Mussap
authors.forename: G
authors.initials: G
authors.lastname: Icardi
authors.forename: F
authors.initials: F
authors.lastname: Bobbio Pallavicini
authors.forename: C
authors.initials: C
authors.lastname: Viscoli
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D004352:Drug Resistance, Microbial; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D007711:Klebsiella pneumoniae / Q000187:drug effects; D055624:Methicillin-Resistant Staphylococcus aureus; D015995:Prevalence; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins