A retrospective study of risk factors for poor outcomes in methicillin-resistant staphylococcus aureus (MRSA) infection in surgical patients

Abstract

BackgroundSince its isolation, Methicillin-resistant Staphlococcus aureus (MRSA) has become a major cause of hospital acquired infection (HAI), adverse patient outcome and overall resource utilisation. It is endemic in Scotland and widespread in Western hospitals. MRSA has been the subject of widespread media interest- a manifestation of concerns about sterile surgical techniques and hospital cleanliness. This study aimed to investigate patient outcome of MRSA infections over the last decade at a major orthopaedic trauma centre. The objective was to establish the association of variables, such as patient age and inpatient residence, against patient outcome, in order to quantify significant relationships; facilitating the evaluation of management strategies with an aim to improving patient outcomes and targeting high-risk procedures.MethodsThis is a retrospective study of the rates and outcomes of MRSA infection in orthopaedic trauma at the Royal Infirmary of Edinburgh. Data was collated using SPSS 14.0 for Windows(R). Shapiro-Wilkes testing was performed to investigate the normality of continuous data sets (e.g: age). Data was analysed using both Chi-Squared and Fisher's exact tests (in cases of expected values under 5)ResultsThis study found significant associations between adverse patient outcome (persistent deep infection, osteomyelitis, the necessity for revision surgery, amputation and mortality) and the following patient variables: Length of inpatient stay, immuno-compromise, pre-admission residence in an institutional setting (such as a residential nursing home) and the number of antibiotics used in patient care. Despite 63% of all infections sampled resulting from proximal femoral fractures, no association between patient outcome and site of infection or diagnosis was found. Somewhat surprisingly, the relationship between age and outcome of infection was not proved to be significant, contradicting previous studies suggesting a statistical association. Antibiotic prophylaxis, previously identified as a factor in reducing overall incidence of MRSA infection, was not found to be significantly associated with outcome.ConclusionsEarly identification of high-risk patients as identified by this study could lead to more judicious use of therapeutic antibiotics and reductions in adverse outcome, as well as socioeconomic cost. These results could assist in more accurate risk stratification based on evidence based evaluation of the significance of the risk factors investigated.

Prevalence and Antibiotic Susceptibility Patterns of Methicillin Resistant Staphylococcus Aureus in Patients Attending the Laquintinie Hospital Douala, Cameroon

“…Moreover, participants with history of antibiotic use, those who use antibiotics frequently and those who use non-prescribed antibiotics recorded a MRSA prevalence of 100%, 53.3% and 86.7% respectively. These findings correspond with findings in Scotland where participants with great antibiotic exposure and use of non-prescribed antibiotics recorded higher MRSA prevalence [32].…”

European perspective and update on the management of nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid

“…A large number of studies evaluating MRSA risk factors have been published . These demonstrate that the utility of trying to identify patients from such approaches to target MRSA treatment is highly variable and does not achieve dependable positive levels of accuracy although negative prediction tends to be very good.…”

“…ICU versus community, the clinical condition in question e.g. pneumonia versus orthopaedic trauma, and the background rate of MRSA in terms of high and low prevalence areas . The presence of multiple risk factors improves the likelihood of the presence of MRSA sepsis .…”

Phytochemical, Antimicrobial, and Toxicological Evaluation of Traditional Herbs Used to Treat Sore Throat

“…Methicillin-resistant S. aureus (MRSA) strains have acquired a gene that makes them resistant to all beta-lactam antibiotics. It is estimated that more people have died of MRSA infection than of other life threating diseases like HIV/AIDS and tuberculosis [ 10 ]. Hence, search for novel antimicrobial compounds or alternative therapy for these resistant infectious agents is inevitable.…”