Focus on the prophylaxis, epidemiology and therapy of methicillin-resistant Staphylococcus aureus surgical site infections and a position paper on associated risk factors: the perspective of an Italian group of surgeons

Sganga, Gabriele; Tascini, Carlo; Sozio, Emanuela; Carlini, Massimo; Chirletti, Piero; Cortese, Francesco; Gattuso, Roberto; Granone, Pierluigi; Pempinello, C.; Sartelli, Massimo; Colizza, S.

doi:10.1186/s13017-016-0086-1

Cited by 24 publications

(22 citation statements)

References 44 publications

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“…The main differences between MRSA and MSSA endocarditis in our study population was the greater frequency of the former in patients with COPD and its association with a longer interval between symptom onset and hospital admission (≥ 7 days in around 60% of cases). One reason may be the higher MRSA colonization rate in patients with COPD due to their repeated contact with the health care system [28]. The exacerbation of COPD, mainly during the winter, is one of the principal causes of hospitalization and is often responsible for iatrogenesis, adverse effects, and functional [29].…”

Section: Discussionmentioning

confidence: 99%

Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis

et al. 2020

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Background: S. aureus (SA) infective endocarditis (IE) has a very high mortality, attributed to the age and comorbidities of patients, inadequate or delayed antibiotic treatment, and methicillin resistance, among other causes. The main study objective was to analyze epidemiological and clinical differences between IE by methicillinresistant versus methicillin-susceptible SA (MRSA vs. MSSA) and to examine prognostic factors for SA endocarditis, including methicillin resistance and vancomycin minimum inhibitory concentration (MIC) values > 1 μg/mL to MRSA. Methods: Patients with SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017. Results: We studied 437 patients with SA endocarditis, which was MRSA in 13.5% of cases. A greater likelihood of history of COPD (OR 3.19; 95% CI 1.41-7.23), invasive procedures, or recognized infection focus in the 3 months before IE onset (OR 2.9; 95% CI 1.14-7.65) and of diagnostic delay (OR 3.94; 95% CI 1.64-9.5) was observed in patients with MRSA versus MSSA endocarditis. The one-year mortality rate due to SA endocarditis was 44.3% and associated with decade of endocarditis onset (1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999) (OR 8.391; 95% CI (2.82-24.9);2000-2009; 95% CI 2.92-14.06); active neoplasm (OR 6.63; 95% CI 1.7-25.5) and sepsis (OR 2.28; 95% CI 1.053-4.9). Methicillin resistance was not associated with higher IE-related mortality (49.7 vs. 43.1%; p = 0.32). Conclusion: MRSA IE is associated with COPD, previous invasive procedure or recognized infection focus, and nosocomial or healthcare-related origin. Methicillin resistance does not appear to be a decisive prognostic factor for SA IE.

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Section: Discussionmentioning

confidence: 99%

Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis

et al. 2020

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“…Furthermore, protective factors were an adequate antibiotic prophylaxis, laparoscopic surgery, and the presence in the hospital of an active surveillance program for infection control [8]. …”

Section: Introductionmentioning

confidence: 99%

Early recognition of methicillin-resistant Staphylococcus aureus surgical site infections using risk and protective factors identified by a group of Italian surgeons through Delphi method

Sganga

Tascini²,

Sozio

et al. 2017

World J Emerg Surg

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BackgroundSurgical site infections (SSIs) constitute a major clinical problem in terms of morbidity, mortality, duration of hospital stay, and overall costs. The bacterial pathogens implicated most frequently are Streptococcus pyogenes (S. pyogenes) and Staphylococcus aureus (S. aureus). The incidence of methicillin-resistant S. aureus (MRSA) SSIs is increasing significantly. Since these infections have a significant impact on hospital budgets and patients’ health, their diagnosis must be anticipated and therapy improved. The first step should be to evaluate risk factors for MRSA SSIs.MethodsThrough a literature review, we identified possible major and minor risk factors for, and protective factors against MRSA SSIs. We then submitted statements on these factors to 228 Italian surgeons to determine, using the Delphi method, the degree of consensus regarding their importance. The consensus was rated as positive if >80% of the voters agreed with a statement and as negative if >80% of the voters disagreed. In other cases, no consensus was reached.ResultsThere was positive consensus that sepsis, >2 weeks of hospitalization, age >75 years, colonization by MRSA, and diabetes were major risk factors for MRSA SSIs. Other possible major risk factors, on which a consensus was not reached, e.g., prior antibiotic use, were considered minor risk factors. Other minor risk factors were identified. An adequate antibiotic prophylaxis, laparoscopic technique, and infection committee surveillance were considered protective factors against MRSA SSIs. All these factors might be used to build predictive criteria for identifying SSI due to MRSA.ConclusionsIn order to help to recognize and thus promptly initiate an adequate antibiotic therapy for MRSA SSIs, we designed a gradation of risk and protective factors. Validation, ideally prospective, of this score is now required. In the case of a SSI, if the risk that the infection is caused by MRSA is high, empiric antibiotic therapy should be started after debriding the wound and collecting material for culture.

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“…Desirable is to start antibiotics within three hours of presentation to the hospital, which is considered as a golden window of opportunity 12 . Sganga (2016) also suggest considering treatment of exposed contacts of MSSA infected cases with prophylactic antibiotics whether they exhibit any sign or symptom of infection as exposed contacts are at particular risk for themselves and to the community 13 . Prompt initiation of treatment with fluids, inotropes and the first dose of antibiotic can make difference in terms of morbidity outcome.…”

Section: Discussionmentioning

confidence: 99%

Toxic shock and mortality in a dialysis patient

Mahmood

Imran

Balkhair

2018

Int. j. endorsing health sci. res.

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Background: Staphylococcus and Streptococcal infections are a matter of serious concern in the dialysis population especially those having tunnel catheter access. Importance of these organisms is their virulent nature, higher incidence and prevalence in tunnel catheters resulting in significant morbidity and mortality. Staphylococcal toxic shock syndrome (STSS) is an uncommon but potentially fatal disease with multisystem involvement. This is a case of toxin-producing methicillin sensitive staph aureus (MSSA) which is known to have high mortality. A high degree of clinical suspicion and prompt management is necessary to avoid fatality. The aim of the study was to get the idea for the management of the toxic shock in terms of reducing the morbidity and mortality rate. Case presentation: This case progressed to state of shock within few hours of presentation to emergency room and admission, attributed to be toxic shock with multi-organ failure. Management and Results: In the management of the patient at the very beginning the infected catheter was removed further aggressive resuscitation and empirical antibiotics were administered but this case resulted into a fatality. Conclusion: The early action for source removal of the infection, appropriate antibiotic therapy and adjuvant therapy including clindamycin and immunoglobulin can effectively treat the toxic shock and its related complications.

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Focus on the prophylaxis, epidemiology and therapy of methicillin-resistant Staphylococcus aureus surgical site infections and a position paper on associated risk factors: the perspective of an Italian group of surgeons

Cited by 24 publications

References 44 publications

Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis

Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis

Early recognition of methicillin-resistant Staphylococcus aureus surgical site infections using risk and protective factors identified by a group of Italian surgeons through Delphi method

Toxic shock and mortality in a dialysis patient

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