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JAC Advance Access originally published online on August 18, 2006
Journal of Antimicrobial Chemotherapy 2006 58(4):878-881; doi:10.1093/jac/dkl343
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Effect of individual- and group-level antibiotic exposure on MRSA isolation: a multilevel analysis

Arno Muller1, Frédéric Mauny2, Daniel Talon1, Peter T. Donnan3, Stephan Harbarth4 and Xavier Bertrand1,*

1 Service d'Hygiène hospitalière et d'Epidémiologie moléculaire, Centre Hospitalier Universitaire Jean Minjoz 25030 Besançon, France 2 Département d'information médicale, Centre Hospitalier Universitaire Jean Minjoz Besançon, France 3 Tayside Centre for General Practice, University of Dundee UK 4 Service de Prévention et Contrôle de l'Infection Hôpitaux Universitaires de Genève, Switzerland

Received 16 May 2006; returned 20 July 2006; revised 27 July 2006; accepted 31 July 2006

*Corresponding author. Tel: +33-363082240; Fax: +33-381668914; E-mail: xavier.bertrand{at}univ-fcomte.fr

Objectives: To observe the relative role of individual and group-level antimicrobial selective pressure on subsequent methicillin-resistant Staphylococcus aureus (MRSA) isolation in a university hospital.

Methods: For this purpose, 18 596 patients were included in a retrospective statistical analysis, applying multilevel modelling with discrete time intervals at the lowest level. Individual-level and hospital group variables on antimicrobial exposure and MRSA colonization pressure were collected from computerized databases.

Results: The simultaneous hospital group- and individual-level analysis showed individual exposure to fluoroquinolones and collective exposure to penicillins to be associated with MRSA isolation after adjustment for colonization pressure and other potential confounders.

Conclusions: These results support efforts to reduce prescriptions of selected antimicrobial drug classes such as fluoroquinolones and show the added value of multilevel analysis for research on the adverse outcomes of antibiotic prescribing.

Keywords: methicillin-resistant Staphylococcus aureus , antimicrobial use , individual exposure , ecological bias


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