Impact of an antimicrobial stewardship program on optimizing linezolid consumption and susceptibility in intensive care unit patients with methicillin-resistance staphylococcus aureus: a retrospective cohort study.

backgroundThe 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.

methodsA 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.

resultsFollowing 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.

conclusionIt 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.