title: Ten-year decrease of acquired methicillin-resistant Staphylococcus aureus (MRSA) bacteremia at a single institution: the result of a multifaceted program combining cross-transmission prevention and antimicrobial stewardship.
abstract: BACKGROUND
  In France, the proportion of MRSA has been over 25% since 2000. Prevention of hospital-acquired (HA) MRSA spread is based on isolation precautions and antibiotic stewardship. At our institution, before 2000, the Infection Disease and the Infection Control teams had failed to reduce HA-MRSA rates.
  
  
  OBJECTIVE
  We implemented a multifaceted hospital-wide prevention program and measured the effects on HA-MRSA colonization and bacteremia rates between 2000 and 2009. From 2000 to 2003, active screening and decontamination of ICU patients, hospital wide alcohol based hand rubs (ABHR) use, control of specific classes of antibiotics, compliance audits, and feed-backs to the care providers were successively implemented. The efficacy of the program was assessed by HA-MRSA colonized and bacteremic patient rates per 1000 patient-days in patients hospitalized for more than twenty-four hours.
  
  
  RESULTS
  Compliance with the isolation practices increased between 2000 and 2009. Consumption of ABHR increased from 6.8 L to 27.5 L per 1000 patient-days. The use of antibiotic Defined Daily Doses (DDD) per 1000 patient-days decreased by 31%. HA-MRSA colonization decreased by 84% from 1.09 to 0.17 per 1000 patient-days and HA-MRSA bacteremia by 93%, from 0.15 to 0.01 per 1000 patient-days (p < 10-7 for each rate).
  
  
  CONCLUSIONS
  In an area highly endemic for MRSA, a multifaceted prevention program allows for sustainable reduction in HA-MRSA bacteremia rates.
authors.affiliation: Infection Control Committee, Groupe hospitalier Paris Saint Joseph, Paris, France. bmisset@hpsj.fr.
authors.forename: Annie
authors.initials: A
authors.lastname: Chalfine
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Kitzis
authors.forename: Yvonnick
authors.initials: Y
authors.lastname: Bezie
authors.forename: Adel
authors.initials: A
authors.lastname: Benali
authors.forename: Laurence
authors.initials: L
authors.lastname: Perniceni
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Nguyen
authors.forename: Marie Françoise
authors.initials: MF
authors.lastname: Dumay
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Gonot
authors.forename: Gilles
authors.initials: G
authors.lastname: Rejasse
authors.forename: Fred
authors.initials: F
authors.lastname: Goldstein
authors.forename: Jean
authors.initials: J
authors.lastname: Carlet
authors.forename: Benoît
authors.initials: B
authors.lastname: Misset