Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals

OBJECTIVE: To investigate relationships between the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and the use of different classes of antimicrobials in Belgian hospitals. DESIGN: Using Pearson correlation coefficients, the number of new nosocomial MRSA-colonized or -infected patients in the second half of 1994 and the first half of 1995 reported by the national MRSA surveillance program was compared with use of various antimicrobial classes as reported by the National Institute for Sickness and Disability Insurance. Relationships between different classes of antimicrobials were evaluated in a correlation matrix. MRSA incidence, antimicrobial use, and potential confounding factors were included in a multiple linear regression analysis. SETTING: 50 hospitals in Belgium. RESULTS: The use of a number of different classes of antimicrobials was interrelated. In the multivariate analysis, the incidence of nosocomial MRSA increased with increasing use of ceftazidime and cefsulodin (P=.0003), amoxicillin with clavulanic acid (P=.02), and quinolones (P=.005). No association was found between MRSA incidence and total antimicrobial use. CONCLUSIONS: The relationships between antimicrobial use and MRSA are complex. Interventions aimed at promoting more rational prescribing patterns should be supported by adequate experimental and epidemiological evidence. Advice for preventing and controlling MRSA has focused mainly on hygienic measures and precautions to avoid cross-transmission; the role of relieving antimicrobial pressure needs to be clarified.