Preoperative Nasal Methicillin-Resistant Staphylococcus aureus Status, Surgical Prophylaxis, and Risk-Adjusted Postoperative Outcomes in Veterans

2011 ◽  
Vol 32 (8) ◽  
pp. 791-796 ◽  
Author(s):  
Kalpana Gupta ◽  
Judith Strymish ◽  
Youmna Abi-Haidar ◽  
Sandra A. Williams ◽  
Kamal M. F. Itani
Keyword(s):  
Staphylococcus Aureus ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Administrative Databases ◽  
Surgical Prophylaxis ◽  
Improvement Program ◽  
Skin Preparation ◽  
Methicillin Resistant ◽  
Surgical Infection ◽  
Increased Risk

Objectives.To determine whether preoperative nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage is a significant predictor of postoperative infections, after accounting for surgical infection risk and surgical prophylaxis.Design.Retrospective cohort study.Patients.Veterans Affairs (VA) Boston patients who had nasal MRSA polymerase chain reaction screening performed in the 31 days before clean or clean contaminated surgery in 2008–2009.Methods.Postoperative MRSA clinical cultures and infections, total surgical site infections (SSIs), and surgical prophylaxis data were abstracted from administrative databases. MRSA infections were confirmed via chart review. Multivariate analysis of risk factors for each outcome was conducted using Poisson regression. SSI risk index was calculated for a subset of 1,551 patients assessed by the VA National Surgical Quality Improvement Program.Results.Among 4,238 eligible patients, 279 (6.6%) were positive for preoperative nasal MRSA. Postoperative MRSA clinical cultures and infections, including MRSA SSIs, were each significantly increased in patients with preoperative nasal MRSA. After adjustment for surgery type, vancomycin prophylaxis, chlorhexidine/alcohol surgical skin preparation, and SSI risk index, preoperative nasal MRSA remained significantly associated with postoperative MRSA cultures (relative risk [RR], 8.81; 95% confidence interval [CI], 3.01–25.82) and infections (RR, 8.46; 95% CI, 1.70–42.04). Vancomycin prophylaxis was associated with an increased risk of total SSI in those negative for nasal MRSA (RR, 4.34; 95% CI, 2.19–8.57) but not in patients positive for nasal MRSA.Conclusions.In our population, preoperative nasal MRSA colonization was independently associated with MRSA clinical cultures and infections in the postoperative period. Vancomycin prophylaxis increased the risk of total SSI in nasal MRSA-negative patients.

scholarly journals The Prevalence of MRSA Nasal Carriage in Preoperative Pediatric Orthopaedic Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
J. J. Walrath ◽  
W. L. Hennrikus ◽  
C. Zalonis ◽  
A. M. Dyer ◽  
J. E. Latorre
Keyword(s):  
Staphylococcus Aureus ◽  
Risk Factor ◽  
Postoperative Infection ◽  
Pediatric Patients ◽  
Surgical Site Infections ◽  
Nasal Carriage ◽  
Surgical Prophylaxis ◽  
Methicillin Resistant ◽  
Orthopaedic Patients ◽  
Pediatric Orthopaedic

Nasal carriage of methicillin-resistantStaphylococcus aureus(MRSA) has been described as a risk factor for postsurgical infection. The purpose of this study is to determine the prevalence of MRSA in pediatric orthopaedic patients and whether being a MRSA carrier is a predictor of postoperative infection. Six hundred and ninety-nine consecutive pediatric patients who underwent MRSA nasal screening prior to surgery were studied. Postoperative cultures, total surgical site infections (SSIs), and epidemiological and surgical prophylaxis data were reviewed. Forty-four of 699 patients (6.29%) screened positive for MRSA. Nine of the 44 patients (20.5%) that screened positive for MRSA had a subsequent SSI compared to 10 of the 655 patients (1.52%) that screened negative (p<0.05). All 9 patients with a SSI had myelomeningocele. The prevalence of MRSA was 6.30% and was predictive of postoperative infection. Children with myelomeningocele were at the highest risk for having a positive MRSA screening and developing SSI.

scholarly journals Sanguiin H-6 Fractionated from Cloudberry (Rubus chamaemorus) Seeds Can Prevent the Methicillin-Resistant Staphylococcus aureus Biofilm Development during Wound Infection

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1481
Author(s):  
John Jairo Aguilera-Correa ◽  
Sara Fernández-López ◽  
Iskra Dennisse Cuñas-Figueroa ◽  
Sandra Pérez-Rial ◽  
Hanna-Leena Alakomi ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Wound Infection ◽  
Preventive Measure ◽  
Surgical Site Infections ◽  
Infection Model ◽  
Growth Media ◽  
Methicillin Resistant ◽  
Biofilm Development

Staphylococcus aureus is the most common cause of surgical site infections and its treatment is challenging due to the emergence of multi-drug resistant strains such as methicillin-resistant S. aureus (MRSA). Natural berry-derived compounds have shown antimicrobial potential, e.g., ellagitannins such as sanguiin H-6 and lambertianin C, the main phenolic compounds in Rubus seeds, have shown antimicrobial activity. The aim of this study was to evaluate the effect of sanguiin H-6 and lambertianin C fractionated from cloudberry seeds, on the MRSA growth, and as treatment of a MRSA biofilm development in different growth media in vitro and in vivo by using a murine wound infection model where sanguiin H-6 and lambertianin C were used to prevent the MRSA infection. Sanguiin H-6 and lambertianin C inhibited the in vitro biofilm development and growth of MRSA. Furthermore, sanguiin H-6 showed significant anti-MRSA effect in the in vivo wound model. Our study shows the possible use of sanguiin H-6 as a preventive measure in surgical sites to avoid postoperative infections, whilst lambertianin C showed no anti-MRSA activity.

scholarly journals MRSA – ‘Bug-Bear’ of a Surgical Practice: Reducing the Incidence of MRSA Surgical Site Infections

2006 ◽  
Vol 88 (2) ◽  
pp. 222-223 ◽  
Author(s):  
Andrea Guyot ◽  
Graham Layer
Keyword(s):  
Staphylococcus Aureus ◽  
Surgical Site Infection ◽  
Orthopaedic Surgery ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Methicillin Resistant ◽  
Surgical Practice ◽  
Department Of Health

Adverse publicity (the ‘superbug') has demonstrated that the problem of MRSA (methicillin-resistant Staphylococcus aureus) is prevalent in many of the country's most prestigious hospitals. The results of the mandatory UK Department of Health (DH) surveillance for early surgical site infections in orthopaedic surgery (SSIS) have been published recently for the period April 2004 to March 2005 when 41,242 operations were studied (< http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsStatistic > 28 October 2005). Infection rates were generally and gratifyingly low but 48% of surgical site infections were caused by Staph. aureus and of those 68% were MRSA. The following article will discuss the aetiology and prevention of MRSA surgical site infection.

scholarly journals Healthcare resources attributable to methicillin-resistant Staphylococcus aureus orthopedic surgical site infections

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Haruhisa Fukuda ◽  
Daisuke Sato ◽  
Tetsuya Iwamoto ◽  
Koji Yamada ◽  
Kazuhiko Matsushita
Keyword(s):  
Staphylococcus Aureus ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Healthcare Resource Utilization ◽  
Prevention Measures ◽  
Healthcare Resources ◽  
Methicillin Resistant ◽  
Japanese Residents ◽  
Almost All

Abstract The number of orthopedic surgeries is increasing as populations steadily age, but surgical site infection (SSI) rates remain relatively consistent. This study aimed to quantify the healthcare resources attributable to methicillin-resistant Staphylococcus aureus (MRSA) SSIs in orthopedic surgical patients. The analysis was conducted using a national claims database comprising data from almost all Japanese residents. We examined patients who underwent any of the following surgeries between April 2012 and March 2018: amputation (AMP), spinal fusion (FUSN), open reduction of fracture (FX), hip prosthesis (HPRO), knee prosthesis (KPRO), and laminectomy (LAM). Propensity score matching was performed to identify non-SSI control patients, and generalized estimating equations were used to estimate the differences in outcomes between the case and control groups. The numbers of MRSA SSI cases (infection rates) ranged from 64 (0.03%) to 1,152 (2.33%). MRSA SSI-attributable increases in healthcare expenditure ranged from $11,630 ($21,151 vs. $9,521) for LAM to $35,693 ($50,122 vs. $14,429) for FX, and increases in hospital stay ranged from 40.6 days (59.2 vs. 18.6) for LAM to 89.5 days (122.0 vs. 32.5) for FX. In conclusion, MRSA SSIs contribute to substantial increases in healthcare resource utilization, emphasizing the need to implement effective infection prevention measures for orthopedic surgeries.

scholarly journals What Is the Primary Driver of Preoperative Vancomycin Use? It’s Not Methicillin-resistant Staphylococcus aureus—or Allergy

2020 ◽  
Vol 71 (10) ◽  
pp. 2732-2735
Author(s):  
Judith M Strymish ◽  
William O’ Brien ◽  
Kamal Itani ◽  
Kalpana Gupta ◽  
Westyn Branch-Elliman
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Veterans Affairs ◽  
Common Reason ◽  
Surgical Prophylaxis ◽  
Surgical Specialty ◽  
Methicillin Resistant ◽  
Primary Driver ◽  
Mrsa Colonization

Abstract Factors driving vancomycin surgical prophylaxis are poorly understood. In a national Veterans Affairs cohort with manually validated data, surgical specialty (cardiac, orthopedics) and perception of high facility methicillin-resistant Staphylococcus aureus (MRSA) prevalence—not MRSA colonization—were the primary drivers of prescribing. A β-lactam allergy was the second most common reason. These data may inform perioperative stewardship.

Poor Functional Status as a Risk Factor for Surgical Site Infection Due to Methicillin-Resistant Staphylococcus aureus

2008 ◽  
Vol 29 (9) ◽  
pp. 832-839 ◽  
Author(s):  
Deverick J. Anderson ◽  
Luke F. Chen ◽  
Kenneth E. Schmader ◽  
Daniel J. Sexton ◽  
Yong Choi ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Surgical Site Infection ◽  
Functional Status ◽  
Surgical Patients ◽  
Control Group ◽  
Site Infection ◽  
Methicillin Resistant ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
Poor Functional Status

Objective.To identify risk factors for surgical site infection (SSI) due to methicillin-resistant Staphylococcus aureus (MRSA).Design.Prospective case-control study.Setting.One tertiary and 6 community-based institutions in the southeastern United States.Methods.We compared patients with SSI due to MRSA with 2 control groups: matched uninfected surgical patients and patients with SSI due to methicillin-susceptible S. aureus (MSSA). Multivariable logistic regression was used to determine variables independently associated with SSI due to MRSA, compared with each control group.Results.During the 5-year study period, 150 case patients with SSI due to MRSA were identified and compared with 231 matched uninfected control patients and 128 control patients with SSI due to MSSA. Two variables were independendy associated with SSI due to MRSA in both multivariable regression models: need for assistance with 3 or more activities of daily living (odds ratio [OR] compared with uninfected patients, 3.97 [95% confidence interval {CI}, 2.18-7.25]; OR compared with patients with SSI due to MSSA, 3.88 [95% CI, 1.91-7.87]) and prolonged duration of surgery (OR compared with uninfected patients, 1.98 [95% CI, 1.11-3.55]; OR compared with patients with SSI due to MSSA, 2.33 [95% CI, 1.17-4.62]). Lack of independence (ie, poor functional status) remained associated with an increased risk of SSI due to MRSA after stratifying by age.Conclusions.Poor functional status was highly associated with SSI due to MRSA in adult surgical patients, regardless of age. A patient's level of independence can be easily determined, and this information can be used preoperatively to target preventive interventions.

scholarly journals SURVEILLANCE OF BACTERIA METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AND PSEUDOMONAS AERUGINOSA IN PATIENTS ADMITTED TO ORTHOPEDIC DEPARTMENT IN A TERTIARY REFERRAL HOSPITAL

2018 ◽  
Vol 11 (6) ◽  
pp. 381
Author(s):  
Pulin Bihari Das ◽  
Monali Priyadarshini Mishra ◽  
Siba Narayan Rath
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Site Infections ◽  
Macconkey Agar ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Methicillin Resistant ◽  
Fungal Strains ◽  
Mrsa Strains

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged independently in diverse geographic zones and MRSA and Pseudomonas aeruginosa cause surgical site infections. Nosocomial surveillance in orthopedic surgery wards of the hospital for 16 months is presented.Methods: A total of 621 wound swabs were cultured on blood and MacConkey agar plates for bacteria and Sabouraud dextrose agar for fungi.Results: From 468 bacterial colonies, 98 MRSA and 74 P. aeruginosa strains and 41 fungal strains were isolated, and fungal strains were 13 strains of Aspergillus niger, and 28 strains of Candida albicans. P. aeruginosa and S. aureus strains were susceptible to antibiotics tobramycin, ciprofloxacin, piperacillin, vancomycin, levofloxacin, and amoxyclav. Similarly, A. niger and C. albicans were susceptible to antifungals, amphotericin B (AMB), liposomal AMB, itraconazole, voriconazole, posaconazole, and caspofungin.Conclusion: Isolated MRSA strains were resistant to presently used common antibiotics, which attribute to the leading causatives of post-operative infection in orthopedic wounds, specifically.

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