• Clotilde Couderc, Sarah Jolivet, Anne C M Thiébaut, Caroline Ligier, Laetitia Remy, Anne-Sophie Alvarez, Christine Lawrence, Jérôme Salomon, Jean-Louis Herrmann, Didier Guillemot, and Antibiotic Use and Staphylococcus aureus Resistant to Antibiotics (ASAR) Study Group.
• Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, Institut Pasteur, Paris U657, Institut National de la Santé et de la Recherche Médicale, Paris EA 4499, Université de Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux.
• Clin. Infect. Dis. 2014 Jul 15; 59 (2): 206-15.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is a well-established risk factor for subsequent infection and a key event in interindividual transmission. Some studies have showed an association between fluoroquinolones and MRSA colonization or infection. The present study was performed to identify specific risk factors for MRSA acquisition in long-term care facilities (LTCFs).MethodsA prospective cohort of patients naive for S. aureus colonization was established and followed (January 2008 through October 2010) in 4 French LTCFs. Nasal colonization status and potential risk factors were assessed weekly for 13 weeks after 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 swab samples were always negative served as controls. Matching criteria were center, date of first nasal swab sample, and exposure time.ResultsAmong 451 included patients, 76 MRSA cases were matched to 207 controls and 112 MSSA cases to 208 controls. Multivariable analysis retained fluoroquinolones (odds ratio, 2.17; 95% confidence interval, 1.01-4.67), male sex (2.09; 1.10-3.98), and more intensive care at admission (3.24; 1.74-6.04) as significantly associated with MRSA acquisition, and body-washing assistance (2.85; 1.27-6.42) and use of a urination device (1.79; 1.01-3.18) as significantly associated with MSSA acquisition.ConclusionsOur 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.© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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