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Title: Antibiotic Cycling May Reduce MRSA Infections in Hospital Intensive Care Units
URL: http://www.pslgroup.com/dg/22AC9E.htm
Doctor's Guide
September 4, 2008

CHARLOTTESVILLE, Va -- September 4, 2008 -- Methicillin-resistant Staphylococcus aureus (MRSA) infections can be reduced among patients in the surgical intensive care unit (ICU) by using antibiotic cycling, according to a study published in the September 3 issue of Surgical Infections.

Switching between 2 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 ICU-acquired MRSA infections fell from 3.8 patients per year to none.

The study data spanned 6 years, including the period before cycling began (1997-2001) and the period after it was instituted (2002-2003). The study's key focus was resistant gram-positive cocci, and vancomycin-resistant Enterococcus (VRE).

"Before we began cycling, 67% of the Staphylococcus aureus infections in our surgical ICU were caused by MRSA," said lead author Robert Sawyer, MD, Surgical Trauma Intensive Care Unit, University of Virginia, Charlottesville, Virginia. "Cycling reduced MRSA cases to 36% of that total."

According to Dr. Sawyer, UVA's findings are important, yet need to be confirmed by similar studies in other ICU's.

"If cycling proves effective at other centres, 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.

"However, the problem is very complex and will almost certainly need a variety of interventions to achieve the best outcomes."

While MRSA infection rates fell during cycling, the prevalence of VRE remained virtually unaltered. VRE infection rates rose slightly, from .76 to .98 patients per 100 admissions. In-hospital mortality from VRE dropped from 2.8 to 2.5 patients per year.

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

SOURCE: University of Virginia Health System

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