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Ten-year decrease of acquired methicillin-resistant Staphylococcus aureus (MRSA) bacteremia at a single institution: the result of a multifaceted program combining cross-transmission prevention and antimicrobial stewardship

Annie Chalfine12, Marie-Dominique Kitzis13, Yvonnick Bezie14, Adel Benali135, Laurence Perniceni12, Jean-Claude Nguyen13, Marie Françoise Dumay1, Jacqueline Gonot12, Gilles Rejasse6, Fred Goldstein13, Jean Carlet17 and Benoît Misset178*

Author Affiliations

1 Infection Control Committee, Groupe hospitalier Paris Saint Joseph, Paris, France

2 Infection Control Unit, Groupe hospitalier Paris Saint Joseph, Paris, France

3 Clinical Microbiology Unit, Groupe hospitalier Paris Saint Joseph, Paris, France

4 Pharmacy, Groupe hospitalier Paris Saint Joseph, Paris, France

5 Infectious Disease Team, Groupe hospitalier Paris Saint Joseph, Paris, France

6 Medical Information Unit, Groupe hospitalier Paris Saint Joseph, Paris, France

7 Intensive Care Unit, Groupe hospitalier Paris Saint Joseph, Paris, France

8 Faculté de Médecine, Paris Sorbonne Cité, Université Paris-Descartes, Paris, France

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Antimicrobial Resistance and Infection Control 2012, 1:18  doi:10.1186/2047-2994-1-18

Published: 18 May 2012

Abstract

Background

In France, the proportion of MRSA has been over 25% since 2000. Prevention of hospital-acquired (HA) MRSA spread is based on isolation precautions and antibiotic stewardship. At our institution, before 2000, the Infection Disease and the Infection Control teams had failed to reduce HA-MRSA rates.

Objectives and methods

We implemented a multifaceted hospital-wide prevention program and measured the effects on HA-MRSA colonization and bacteremia rates between 2000 and 2009. From 2000 to 2003, active screening and decontamination of ICU patients, hospital wide alcohol based hand rubs (ABHR) use, control of specific classes of antibiotics, compliance audits, and feed-backs to the care providers were successively implemented. The efficacy of the program was assessed by HA-MRSA colonized and bacteremic patient rates per 1000 patient-days in patients hospitalized for more than twenty-four hours.

Results

Compliance with the isolation practices increased between 2000 and 2009. Consumption of ABHR increased from 6.8 L to 27.5 L per 1000 patient-days. The use of antibiotic Defined Daily Doses (DDD) per 1000 patient-days decreased by 31%. HA-MRSA colonization decreased by 84% from 1.09 to 0.17 per 1000 patient-days and HA-MRSA bacteremia by 93%, from 0.15 to 0.01 per 1000 patient-days (p < 10−7 for each rate).

Conclusions

In an area highly endemic for MRSA, a multifaceted prevention program allows for sustainable reduction in HA-MRSA bacteremia rates.

Keywords:
MRSA; Bacteremia; Hospital-acquired; Isolation precaution; Alcohol based hand rub; Antibiotic stewardship