Fluoroquinolone Use Is a Risk Factor for Methicillin-Resistant Staphylococcus aureus Acquisition in Long-term Care Facilities: A Nested Case-Case-Control Study

Couderc, Clotilde; Jolivet, Sarah; Thiébaut, Anne C. M.; Ligier, Caroline; Remy, Laetitia; Alvarez, Anne‐Sophie; Lawrence, Christine; Salomon, Jérôme; Herrmann, Jean-Louis; Guillemot, Didier; Bernède-Bauduin, Claire; Bertucci, I; Dupont, Céline; Minor, Odile Le; Petit, A; Sorel, T

doi:10.1093/cid/ciu236

Cited by 44 publications

(46 citation statements)

References 34 publications

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“…ESKAPE= an acronym displaying groups of multidrug resistant organisms set by the Infectious Diseases Society of America [1]. [93,94] ESBL [95] CRE [75,96,97] …”

Section: Impact On Outcomesmentioning

confidence: 99%

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Pogue

Kaye

Cohen

et al. 2015

Clinical Microbiology and Infection

120

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The past decade has brought a significant rise in antimicrobial resistance, and the ESKAPE pathogens have become a significant threat to public health. Three epidemiological features that negatively impact patients, which are consistently seen with the ESKAPE pathogens, are the following: 1) there has been a rise in incidence of these organisms as causative human pathogens, 2) there has been a significant increase in antimicrobial resistance in these bacterial species, and 3) the infections caused by these resistant strains are associated with worse outcomes when compared with infections caused by their susceptible counterparts. Significant delays in time to appropriate antimicrobial therapy of up to 5 days have been reported in infections due to these organisms and this is the strongest predictor of mortality with ESKAPE pathogens, particular in critically ill patients, where every hour delay has an incremental survival disadvantage for patients. Strategies to decrease these delays are urgently needed. Although routine broad-spectrum empiric coverage for these organisms would ideally limit this delay, agents with activity against these organisms are sometimes less effective, have significant toxicity risk, and their use can result in the development of resistance. Therefore, strategies to optimize therapy, although limiting unnecessary use of broad-spectrum antimicrobials, are urgently needed. This review will discuss potential strategies to optimize empiric therapy in the age of multi-drug resistance, the limitations of these strategies, and will discuss future directions and opportunities.

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“…ESKAPE= an acronym displaying groups of multidrug resistant organisms set by the Infectious Diseases Society of America [1]. [93,94] ESBL [95] CRE [75,96,97] …”

Section: Impact On Outcomesmentioning

confidence: 99%

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Pogue

Kaye

Cohen

et al. 2015

Clinical Microbiology and Infection

120

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“…pneumonia, UTIs, skin and soft tissues infections) should be based on national or international guidelines, and adapted to local resistance data [4]. The use of third-generation cephalosporins and fluoroquinolones should be avoided whenever possible, as they present a high risk of promoting emergence of bacterial resistance (methicillin-resistant Staphylococcus aureus, fluoroquinolone-resistant Enterobacteriaceae, extended-spectrum β-lactamase-producing Enterobacteriaceae) and of C. difficile infections [4,60,61].…”

Section: Target Areas Where Antibiotic Misuse Is Commonmentioning

confidence: 99%

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes.

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“…These results suggest that fluoroquinolone use shortens the MSSA colonization duration, but fluoroquinolone use is also a risk factor for MRSA acquisition (19); therefore, it is essential that they be prescribed with caution in health care facilities. Finally, because a longer duration of colonization has important implications for infection control policies and patient care and may be associated with an increased risk of infection, further research on the natural history of nasal and extranasal S. aureus colonization and on this bacterium's fitness is needed.…”

Section: Discussionmentioning

confidence: 96%

“…Patients were included if they were not colonized with S. aureus at admission (negative nasal and perineal swab specimens), Ն18 years old, and hospitalized for a neurologic disorder with an expected stay of Ն2 months, as detailed previously (19). An institutional review board (Comité de Protection des Personnes Île-de-France XI) approved the study protocol (reference 07032); no written informed consent was obtained from the patients because the study interventions were standard care.…”

Section: Settings and Study Design The Antibiotic Use And Staphylocomentioning

confidence: 99%

Fluoroquinolone Impact on Nasal Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization Durations in Neurologic Long-Term-Care Facilities

Couderc

Thiébaut

Lawrence

et al. 2015

Antimicrob Agents Chemother

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k Staphylococcus aureus nasal carriage is a risk factor for subsequent infection. Estimates of colonization duration vary widely among studies, and factors influencing the time to loss of colonization, especially the impact of antibiotics, remain unclear. We conducted a prospective study on patients naive for S. aureus colonization in 4 French long-term-care facilities. Data on nasal colonization status and potential factors for loss of colonization were collected weekly. We estimated methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) colonization durations using the Kaplan-Meier method and investigated factors for loss of colonization using shared-frailty Cox proportional hazards models. A total of 285 S. aureus colonization episodes were identified in 149 patients. The median time to loss of MRSA or MSSA colonization was 3 weeks (95% confidence interval, 2 to 8 weeks) or 2 weeks (95% confidence interval, 2 to 3 weeks), respectively. In multivariable analyses, the methicillin resistance phenotype was not associated with S. aureus colonization duration (P ‫؍‬ 0.21); the use of fluoroquinolones (hazard ratio, 3.37; 95% confidence interval, 1.31 to 8.71) and having a wound positive for a nonnasal strain (hazard ratio, 2.17; 95% confidence interval, 1.15 to 4.07) were associated with earlier loss of MSSA colonization, while no factor was associated with loss of MRSA colonization. These results suggest that the methicillin resistance phenotype does not influence the S. aureus colonization duration and that fluoroquinolones are associated with loss of MSSA colonization but not with loss of MRSA colonization.

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Fluoroquinolone Use Is a Risk Factor for Methicillin-Resistant Staphylococcus aureus Acquisition in Long-term Care Facilities: A Nested Case-Case-Control Study

Abstract: Our results suggest that fluoroquinolones are a risk factor for MRSA acquisition. Control measures to limit MRSA spread in LTCFs should also be based on optimization of fluoroquinolone use.

Cited by 44 publications

References 34 publications

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Fluoroquinolone Impact on Nasal Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization Durations in Neurologic Long-Term-Care Facilities

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