Evaluation of an Intervention Designed to Decrease the Rate of Nosocomial Methicillin-ResistantStaphylococcus aureusInfection by Encouraging Decreased Fluoroquinolone Use

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Abstract
Objective.: Society for Health Care Epidemiology guidelines recommend decreasing the use of fluoroquinolone antibiotics in institutions where methicillin-resistantStaphylococcus aureus(MRSA) is endemic. We evaluated whether an intervention to limit fluoroquinolone use was associated with a lower rate of nosocomial MRSA infection and summarized changes in antibiotic use, changes in other variables potentially correlated with a lower rate of MRSA infection, and rates of nosocomial infections due to other pathogens.Design.: Single-center quasi-experimental design. A time series of nosocomial MRSA infections was measured at monthly intervals from July 2001 through June of 2004; there were 80 MRSA infections recorded. Segmented regression analysis (ie, quasi-Poisson generalized linear models) was used to evaluate variables possibly associated with the nosocomial MRSA infection rate.Setting.: An 87-bed Veterans Affairs teaching hospital with an extended-care facility.Intervention.: A physician-directed computer-generated intervention designed to limit the use of fluoroquinolone antibiotics was initiated, and institutional changes in antibiotic use and nosocomial MRSA infection rates were tracked.Results.: After the intervention, fluoroquinolone use decreased by approximately 34%, and levofloxacin use decreased by approximately 50%. Decreased fluoroquinolone use was offset by increased cephalosporin, piperacillin-tazobactam, and trimethoprim-sulfamethoxazole use. The nosocomial MRSA infection rate decreased from 1.37 to 0.63 episodes per 1,000 patient-days after the study intervention (P= .02). Coagulase-negativeStaphylococcusandEnterococcusinfection rates also decreased. However, the rate of infection with gram-negative organisms increased. The rate of MRSA infection was positively correlated with levofloxacin use (P= .01) and azithromycin use (P= .08), whereas it was negatively correlated with summer season (P= .05). In a subsequent model, the rate of MRSA infection was negatively correlated with the study intervention (P= .04).Conclusion.: Reduction in the institutional use of fluoroquinolones may be associated with a lower nosocomial MRSA infection rate.

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