Swidan Heba, Salama Mayada, Saleh Eman, Mohamed Ayat, Tarek Salma, Sweedy Rahma
Al- Gomhoreya General Hospital, Ministry of Health, Alexandria, Egypt.
Health Affairs Directorate, Ministry of Health, Dakahlia, Egypt.
BMC Infect Dis. 2025 Sep 16;25(1):1111. doi: 10.1186/s12879-025-11510-4.
The empirical use of linezolid as a first-line agent for Methicillin-Resistant Staphylococcus Aureus (MRSA) without a clear indication is of high concern. This study aims to investigate the impact of an Antimicrobial Stewardship Program (ASP) on linezolid consumption and susceptibility in Intensive Care Unit (ICU). In particular, for patients with MRSA infection, ensuring optimized anti-MRSA therapy to align with international/national guidelines.
A retrospective cohort study was conducted from 01.10.2022 to 31.03.2024 in the ICU of Al-Gomhoreya General Hospital, Alexandria, Egypt. This study included a total of 168 ICU adult patients; older than 18 years old and whom were prescribed anti-MRSA therapy (vancomycin, teicoplanin, or linezolid). The present study assessed the impact of ASP implementation by comparing six months before ASP, i.e. from 01.10.2022 to 31.03.2023 and following ASP implementation from 01.10.2023 to 31.03.2024. Hence, evaluating adherence to hospital protocol for MRSA management and antibiotic timeout process. One of the principal elements that this study focused on was to quantify the consumption of Linezolid before and after ASP implementation, which was measured utilizing the World Health Organization (WHO) standardized Daily Defined Dose (DDD) per 100 patient days. Thus, enabling evaluating the effect of reducing linezolid usage on MRSA susceptibility to Linezolid and analyzing the overall expenditure on anti-MRSA therapy. The comparative analyses were performed using Permutation Welch Two Sample T-test for the continuous measures, while Chi-squared test or Fisher's exact test were utilized for categorical outcomes.
Following ASP implementation, it was found that adherence to MRSA indication and timeout process significantly increased by approximately 74.3% and 57.9%, with (p values < 0.001 for both), standardized effect sizes (φ) of 0.70 and 0.55, respectively, Linezolid consumption decreased by approximately 85.8% and MRSA sensitivity to Linezolid improved by 18.3%. Furthermore, a reduction of 43% in the overall cost of anti-MRSA therapy was observed.
It was found that implementing an ASP contributes to a substantial reduction in Linezolid consumption and preserving its efficacy by maintaining MRSA susceptibility, while improving adherence to hospital protocols and timeout process. Additionally, it reduces overall expenditures on anti-MRSA therapy. These findings highlight ASP as a viable strategy for combating antibiotic resistance, particularly in resource-limited settings.
在没有明确指征的情况下，经验性地将利奈唑胺作为耐甲氧西林金黄色葡萄球菌（MRSA）的一线用药备受关注。本研究旨在调查抗菌药物管理计划（ASP）对重症监护病房（ICU）中利奈唑胺使用情况和药敏性的影响。特别是对于MRSA感染患者，确保优化抗MRSA治疗以符合国际/国家指南。
2022年10月1日至2024年3月31日在埃及亚历山大港的戈尔霍里亚综合医院ICU进行了一项回顾性队列研究。本研究共纳入168例ICU成年患者；年龄大于18岁且接受抗MRSA治疗（万古霉素、替考拉宁或利奈唑胺）。本研究通过比较ASP实施前的六个月，即2022年10月1日至2023年3月31日以及ASP实施后2023年10月1日至2024年3月31日，评估ASP实施的影响。因此，评估对MRSA管理医院协议和抗生素暂停流程的依从性。本研究关注的主要因素之一是量化ASP实施前后利奈唑胺的使用情况，这是利用世界卫生组织（WHO）每100患者日的标准化限定日剂量（DDD）来衡量的。从而能够评估减少利奈唑胺使用对MRSA对利奈唑胺药敏性的影响，并分析抗MRSA治疗的总体支出。连续测量的比较分析使用排列韦尔奇两样本t检验，而分类结果则使用卡方检验或费舍尔精确检验。
ASP实施后，发现对MRSA指征和暂停流程的依从性显著提高，分别提高了约74.3%和57.9%，（两者p值均<0.001），标准化效应量（φ）分别为0.70和0.55，利奈唑胺使用量减少了约85.8%，MRSA对利奈唑胺的敏感性提高了18.3%。此外，观察到抗MRSA治疗的总成本降低了43%。
发现实施ASP有助于大幅减少利奈唑胺的使用，并通过维持MRSA的药敏性来保持其疗效，同时提高对医院协议和暂停流程的依从性。此外，它还降低了抗MRSA治疗的总体支出。这些发现突出了ASP作为对抗抗生素耐药性的可行策略，特别是在资源有限的环境中。
