title: Impact of an enhanced antibiotic stewardship on reducing methicillin-resistant Staphylococcus aureus in primary and secondary healthcare settings.
abstract: The objective of this study was to evaluate the impact of restricting high-risk antibiotics on methicillin-resistant Staphylococcus aureus (MRSA) incidence rates in a hospital setting. A secondary objective was to assess the impact of reducing fluoroquinolone use in the primary-care setting on MRSA incidence in the community. This was an interventional, retrospective, ecological investigation in both hospital and community (January 2006 to June 2010). Segmented regression analysis of interrupted time-series was employed to evaluate the intervention. The restriction of high-risk antibiotics was associated with a significant change in hospital MRSA incidence trend (coefficient=-0·00561, P=0·0057). Analysis showed that the intervention relating to reducing fluoroquinolone use in the community was associated with a significant trend change in MRSA incidence in community (coefficient=-0·00004, P=0·0299). The reduction in high-risk antibiotic use and fluoroquinolone use contributed to both a reduction in incidence rates of MRSA in hospital and community (primary-care) settings.
authors.affiliation: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Aldeyab
authors.affiliation: Pharmacy and Medicines Management Centre, Northern Health and Social Care Trust, Ballymena, Northern Ireland, UK.
authors.forename: M G
authors.initials: MG
authors.lastname: Scott
authors.affiliation: Microbiology Department, Northern Health and Social Care Trust, Ballymena, Northern Ireland, UK.
authors.forename: M P
authors.initials: MP
authors.lastname: Kearney
authors.affiliation: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK.
authors.forename: Y M
authors.initials: YM
authors.lastname: Alahmadi
authors.affiliation: Pharmacy and Medicines Management Centre, Northern Health and Social Care Trust, Ballymena, Northern Ireland, UK.
authors.forename: F A
authors.initials: FA
authors.lastname: Magee
authors.affiliation: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK.
authors.forename: G
authors.initials: G
authors.lastname: Conlon
authors.affiliation: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: McElnay
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D004363:Drug Utilization / Q000592:standards*; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D055624:Methicillin-Resistant Staphylococcus aureus; D009660:Northern Ireland / Q000453:epidemiology; D011320:Primary Health Care; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D002981:Clindamycin