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Modification in prescribing practices for third-generation cephalosporins and ciprofloxacin is associated with a

L D Liebowitz1, M C Blunt

  • 1The Queen Elizabeth Hospital NHS Trust, King's Lynn, Norfolk, UK. lynne.liebowitz@qehkl.nhs.uk

The Journal of Hospital Infection
|July 8, 2008
PubMed

Insights

An educational intervention significantly reduced hospital infections from meticillin-resistant Staphylococcus aureus (MRSA) by discouraging specific antibiotic use. This study highlights effective strategies for controlling MRSA bacteraemia in healthcare settings.

Area of Science:

  • Infectious Diseases
  • Hospital Epidemiology
  • Antimicrobial Stewardship

Background:

  • Meticillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in hospital settings, leading to difficult-to-treat infections.
  • The use of certain broad-spectrum antibiotics, such as ciprofloxacin and third-generation cephalosporins, has been implicated in the rise of MRSA.
  • Effective strategies are needed to curb the incidence of MRSA bacteraemia and hospital-acquired infections.

Purpose of the Study:

  • To evaluate the impact of an educational intervention aimed at reducing the use of intravenous ciprofloxacin and third-generation cephalosporins.
  • To assess the effect of this intervention on the rates of MRSA bacteraemia and colonisation within a hospital, including the intensive care unit.
  • To determine if changes in antibiotic prescribing correlated with reductions in MRSA infections.

Main Methods:

  • An observational study design was employed, comparing MRSA bacteraemia rates before and after a two-month educational intervention.
  • The intervention discouraged the use of intravenous ciprofloxacin and third-generation cephalosporins.
  • Data on MRSA bacteraemia, MRSA colonisation, meticillin-susceptible Staphylococcus aureus (MSSA) bacteraemia, and antibiotic dispensing were collected and analyzed over 18 months pre-intervention and 16 months post-intervention.

Main Results:

  • A significant reduction of 62.9% in the overall hospital MRSA bacteraemia rate was observed (P<0.001).
  • MRSA colonisation rates decreased by 38.4%, though this was not statistically significant.
  • Hospital dispensing of ciprofloxacin and third-generation cephalosporins fell by 80.4% and 75.2%, respectively. No significant decrease in MSSA bacteraemia was noted.

Conclusions:

  • An educational intervention successfully decreased MRSA bacteraemia rates in a hospital setting.
  • Restricting the use of specific antibiotics like ciprofloxacin and third-generation cephalosporins can be an effective antimicrobial stewardship strategy.
  • Further investigation may be warranted to understand the non-significant reduction in MRSA colonisation and the lack of impact on MSSA bacteraemia.

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