High MRSA prevalence associated with high rate of antibiotic use
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An evaluation of more than 100 Veterans Affairs hospitals showed that hospitals with a higher prevalence of MRSA prescribed more anti-MRSA antibiotics, even after adjusting for stewardship strategies, researchers reported.
The associated between MRSA colonization at admission and hospitals’ use of anti-MRSA antibiotics “was statistically significant [but] relatively small in magnitude,” the researchers wrote in Infection Control & Hospital Epidemiology.
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“I knew that the prevalence of antibiotic resistance varies across geographic regions, and I was curious to see how differences in antibiotic resistance are related to differences in antibiotic use within hospitals,” Daniel J. Livorsi, MD, MSc, an assistant professor of internal medicine and infectious diseases at the University of Iowa Carver College of Medicine, told Healio. “For this specific study, we looked at the prevalence of MRSA colonization in patients who were being admitted to the hospital.”
Livorsi and colleagues performed a retrospective cohort study that included all patients admitted to an acute-care bed at 122 VA hospitals in 2016 — a total of 548,476 patient admissions.
The study demonstrated that the median rate of MRSA prevalence upon hospital admission was 8% (interquartile range [IQR] = 6.7%-9.7%; total range, 3.8%-13.3%). According to the study, across all hospitals, the median use of anti-MRSA and total antibiotics was 96.5 (IQR = 81.1-116.9) and 562.1 (IQR = 505.9-631.6) days of therapy (DOT) per 1,000 days present, respectively.
Overall, MRSA prevalence was “weakly and positively” correlated to anti-MRSA antibiotic use (r = 0.48; P < .0001) and total antibiotic use (r = 0.38; P < .0001).
In a hospital-level risk-adjusted analysis, a hospital’s MRSA prevalence was significantly associated with its monthly use of both anti-MRSA and total antibiotics (incident rate ratio [IRR] = 1.05; 95% CI, 1.02-1.07;IRR = 1.02; 95% CI, 1.01-1.03), and a 5% increase in the hospital’s MRSA prevalence was associated with an increase in the monthly use of anti-MRSA antibiotics and total antibiotics by 23.6 and 8.3 DOT per 1,000 days present, respectively.
“Benchmarking antibiotic use across hospitals will need to account for several factors that differ across hospitals and likely influence antibiotic prescribing,” Livorsi said. “This study showed that the prevalence of MRSA in a hospital's patient population may be a necessary factor to adjust for when making interhospital comparisons on antibiotic use.”
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