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Methicillin-Resistant Staphylococcus aureus and Its Relationship to Antimicrobial Use: Possible Implications for Control

Published online by Cambridge University Press:  02 January 2015

Dominique L. Monnet
Dominique L. Monnet*
Affiliation:
National Center for Hospital Hygiene, Statens Serum Institut, Copenhagen, Denmark
*
National Centre for Hospital Hygiene (46/102), Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; e-mail, dom@ssi.dk
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Abstract

The control of methicillin-resistant Staphylococcus aureus (MRSA) is still an unresolved issue in numerous healthcare institutions worldwide. Guidelines for the control of MRSA in hospitals focus on measures to control cross-transmission and prevent colonization, but rarely specifically mention the control of antimicrobial use. We reviewed the different types of evidence for a causal relationship between MRSA and antimicrobial use by classifying them in four categories: consistent associations, dose-effect relationships, concomitant variations, and arguments to support a plausible biological model to explain this relationship. Although the relative participation of cross-transmission and antimicrobial selection pressure in the level of MRSA observed in a healthcare setting remains to be determined, we found lines of evidence to support the existence of a relationship between MRSA and antimicrobial use in each of the four categories. This review points out the relative lack of studies specifically designed to investigate this aspect of MRSA epidemiology and the need to implement such studies quickly. In the meantime, the results presented here should encourage the implementation of antimicrobial-use improvement programs in hospitals in addition to existing infection control measures, which are still a priority in countries with high MRSA prevalence.

Information

Type
From the Fifth International Conference on the Prevention of Infection
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 8 , August 1998 , pp. 552 - 559
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998 

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