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JAC Advance Access published online on August 18, 2006
Journal of Antimicrobial Chemotherapy, 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
Received May 16, 2006
Revised July 27, 2006
Accepted July 31, 2006

Breif report

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

Arno Muller 1, Frédéric Mauny 2, Daniel Talon 1, Peter T. Donnan 3, Stephan Harbarth 4, and Xavier Bertrand 1 *

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

* To whom correspondence should be addressed.
Xavier Bertrand, E-mail: xavier.bertrand{at}univ-fcomte.fr


  Abstract

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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