Impact of limited cephalosporin use on prevalence of methicillin-resistant Staphylococcus aureus in the intensive care unit.
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.
Bassetti
M
M
Infectious Diseases Division, S. Martino Hospital and University of Genoa School of Medicine, Genoa, Italy. matteo.bassetti@hsanmartino.it
Righi
E
E
Ansaldi
F
F
Molinari
M P
MP
Rebesco
B
B
McDermott
J L
JL
Fasce
R
R
Mussap
M
M
Icardi
G
G
Bobbio Pallavicini
F
F
Viscoli
C
C
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*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins