Fluoroquinolone Use Is a Risk Factor for Methicillin-Resistant Staphylococcus aureus Acquisition in Long-term-Care Facilities: A Nested Case-Case-Control Study.
Clin Infect Dis. 2014 Apr 11;
Authors: Couderc C, Jolivet S, Thiébaut AC, Ligier C, Remy L, Alvarez AS, Lawrence C, Salomon J, Herrmann JL, Guillemot D, on the behalf of the ASAR Study Group
Background. Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is a well-established risk factor for subsequent infection and a key event in inter-individual transmission. Some studies showed an association between fluoroquinolones and MRSA colonization or infection. This study aimed at identifying specific risk factors for MRSA acquisition in long-term-care facilities (LTCFs). Methods. A prospective cohort of patients naïve for S. aureus colonization was established and followed (January 2008-October 2010) in 4 French LTCFs. Nasal colonization status and potential risk factors were assessed weekly for 13 weeks post-inclusion. Variables associated with S. aureus acquisition were identified in a nested-matched case-case-control study using conditional logistic regression models. Cases were patients who acquired MRSA (or methicillin-sensitive S. aureus [MSSA]). Patients whose nasal swabs were always negative served as controls. Matching criteria were center, date of first nasal swab and exposure time. Results. Among 451 included patients, 76 MRSA cases were matched to 207 controls and 112 MSSA cases to 208 controls. Multivariable analysis retained fluoroquinolones (odds ratio [OR], 2.17 [95% confidence interval (CI), 1.01-4.67]), male gender (OR, 2.09 [95% CI, 1.10-3.98]) and more intensive care at admission (OR, 3.24 [95% CI, 1.74-6.04]) as significantly associated with MRSA acquisition, and body-washing assistance (OR, 2.85 [95% CI, 1.27-6.42]) and presence of urination device (OR, 1.79 [95% CI, 1.01-3.18]) for MSSA acquisition. Conclusion. Our results suggest that fluoroquinolones are a risk factor for MRSA acquisition. Control measures to limit MRSA spread in LTCFs should also be based on optimization of fluoroquinolone use.
PMID: 24729496 [PubMed - as supplied by publisher]