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University of Virginia reports promising method for reducing MRSA infections in hospitals

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Doctors at the University of Virginia Health System have significantly reduced methicillin-resistant Staphylococcus aureus (MRSA) infections among surgical intensive care patients by using antibiotic cycling, a method of rotating drugs at regular intervals.

In a study published in the Sept. 3 issue of Surgical Infections, researchers from the University of Virginia report that switching between two antibiotics, linezolid and vancomycin, every 3 months in the surgical ICU decreased the MRSA infection rate from 1.9 to 1.4 patients per 100 admissions. In-hospital mortality from surgical intensive care unit (ICU)-acquired MRSA infections fell from 3.8 patients per year to none.

Study data spanned 6 years, including the period before cycling began (1997 to 2001) and the period after it was instituted (2002 to 2003). The key focus of the study was resistant gram-positive cocci, a subgroup defined as MRSA and vancomycin-resistant Enterococcus (VRE).

“Before we began cycling, 67% of the Staphylococcus aureus infections in our surgical ICU were caused by MRSA,” Robert Sawyer, MD, a professor of surgery and co-director of the univrsity’s Surgical Trauma Intensive Care Unit, said in a press release. “Cycling reduced MRSA cases to 36% of that total.”

The University of Virginia study is the first to assess the impact of antibiotic cycling on gram-positive cocci, according to the press release. Problematic in hospitals, these pathogens tend to develop resistance to antibiotics in sterile and contained environments like ICUs, where patients have weakened immune systems due to severe illness, open wounds, surgical incisions, catheters or other implanted medical devices.

According to Sawyer, the study findings are important, yet need to be confirmed by similar studies in other ICUs.

“If cycling proves effective at other centers, we might be able to turn the tide on antibiotic resistance, at least for MRSA. In the long run, reducing MRSA should decrease the number of deaths among critically ill patients,” he said in the press release. “However, the problem is very complex and will almost certainly need a variety of interventions to achieve the best outcomes.”

Cycling reduced the surgical ICU's overall gram-positive infection rate from 19.6 to 11.8 patients per 100 admissions, according to the press release. It also lowered the rate of infections from resistant gram-positive cocci from 4.6 to 1.7 patients per 100 admissions.

For more information:

• Smith RL, Evans HL, Chong TW, et al. Reduction in rates of methicillin-resistant Staphylococcus aureus infection after introduction of quarterly linezolid/vancomycin cycling in a surgical intensive care unit. Surg Infections. 9(4):423-431.