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.

Fig. 1.

Monthly hospital MRSA incidence vs. use of (a) high-risk antibiotic group (second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones, clindamycin), and (b) alcohol-based hand rub, Causeway Hospital, January 2006 to June 2010. The vertical dashed line indicates the introduction of the intervention in January 2008. DDD, Defined daily dose.

Fig. 2.

Monthly MRSA incidence vs. use of fluoroquinolones, Northern Health and Social Care Trust local community, January 2006 to June 2010. The vertical dashed line indicates the introduction of the intervention in January 2008. DDD, Defined daily dose.