The prevalence of methicillin resistant Staphylococus aureus in orthopaedics in a non-selective screening policy

Hassan, Kamal; Paturi, Anil; Hughes, Carmel; Giles, Sarah

doi:10.1016/s1479-666x(08)80027-3

Cited by 11 publications

(4 citation statements)

References 20 publications

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“…11 The Scottish study recommends clinical risk assessment (CRA) based screening; however, our study (we would have missed 62% of patients if only high-risk group screened) as well as other studies have highlighted that MRSA is not restricted to high-risk group only and selective screening will miss a high number of cases. 25 Although CRA-based screening appears appealing in reducing the cost of screening program but studies have shown that epidemiology of MRSA has changed over a period of time. The last two decades have shown an increase in community-acquired MRSA, a subpopulation of MRSA with unique antibiotic resistance, virulence, and pathogenic capability.…”

Section: Discussionmentioning

confidence: 99%

Can we reduce the number of MRSA screening site swabs in elective orthopedic patients?

Ahmad

Teoh

Lau

et al. 2019

J Orthop Surg (Hong Kong)

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Background: Deep infection after routine elective orthopedic procedures can be catastrophic, leading to further surgery, loss of limb, disability, and risk of mortality. Ring-fencing elective orthopedic ward has been shown to significantly reduce the incidence of all postoperative infections especially with methicillin-resistant Staphylococcus aureus (MRSA). Our hospital's current MRSA screening is a four-site MRSA swabs. Objectives: This study evaluates the possibility of reducing the number of MRSA swab sites as part of a quality improvement project. Study design and methods: Patients on the waiting list for elective orthopedic procedure in our trust who had an MRSA-positive swab from either four sites were analyzed over the time period from January 2012 to December 2014. Those without swabs from all four areas (nose, throat, axilla, and groin) were excluded. Positive swabs of different regions were recorded and compared. Results: There were 138 MRSA-positive patients, giving an incidence of 31 per 10,000 screen/year over that time period. Some patients (n ¼ 31, 22.5%) had a positive swab in more than one site. The positive sites were as follows: nose (69.60%, n ¼ 96), groin (26.10%, n ¼ 36), throat (25.30%, n ¼ 35), and axilla (8.70%, n ¼ 12). In our cohort, we would miss a significant proportion of positive patients if we change it to a two swab screening policy (26.8% for nose and axilla combination; 18.10% for nose and groin combination; and 15.20% for nose and throat). However, we would only miss 2.2% of cases for a nose, groin, and throat three-swab policy. There were also 11 instances, where a previously negative site become positive in the next swab. Conclusion: A three-swab combination of nasal, throat, and groin swabs improves pickup rate of MRSA significantly compared to a two-swab policy and misses only 2.2% compared to a four-swab policy. Axilla swabbing does not make a significant difference to the results. Based on this study, the policy has now been changed from a four-swab to three-swab screening in our trust. This has now been audited four times and they were all negative. This has helped to reduce cost in terms of staff time and resources. We would not recommend screening only the previous positive site for the next repeat screening swabs as there is an 8% chance of missing MRSA carrier status.

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Section: Discussionmentioning

confidence: 99%

Can we reduce the number of MRSA screening site swabs in elective orthopedic patients?

Ahmad

Teoh

Lau

et al. 2019

J Orthop Surg (Hong Kong)

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“…One study noted an incidence rate of up to 66% of presentation with SSI on follow-up after being discharged without any signs of infection. 10 All patients had initial debridement and then treated with antibiotics. These were initially prescribed for a minimum of 1 month and later extended in case of SSI.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Etiological Profile, and Treatment of Surgical Site Infections in Patients With Gunshot Injuries and Bomb Blast Injuries in Pakistan

Shahabuddin¹,

Shahab²,

Sikka³

2013

Infectious Diseases in Clinical Practice

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Purpose: There are few reports on surgical site infections (SSI) after blast injuries. Those occurring in developing nations are a particular source of interest given the recent war in the Middle East. The purpose of this study was to report the incidence, etiological causative agents, and treatment of SSI in patients with gunshot and blast injuries.Methods: A prospective study was performed between January 2008 and December 2008. One thousand four hundred sixteen (1416) patients with gunshot injuries and bomb blast injuries were identified. Three hundred eighty-two patients (27%) were lost to follow-up. Data were collected from bacteriology reports of all surgical site samples and presentation of patients at follow-up.Results: One hundred forty-seven patients (14.2%) developed SSI.Culture reports were positive in one hundred twenty-four patients (84.4%). Only one etiological agent was isolated in 146 patients (99.3%). The most common pathogen was Staphylococcus aureus (44.3%), followed by Escherichia coli (25.7%) and Pseudomonas aeruginosa (16.9%). Methicillin-resistant S aureus (MRSA) was found in 2.7%. The most prescribed antibiotic was ceftriaxone. One hundred thirty-five patients (91.8%) were cured only with the use of antibiotics. There was a statistically significant increase in infection by bomb blast injuries compared with SSI (P G0.0001), whereas no significant correlation was present between SSI and type of fracture, extremity involvement, sex, or surgical procedure. Conclusion:The incidence of surgical site infection is high in gunshot injuries and bomb blast injuries. Staphylococcus aureus was found to be the most common etiological agent, whereas MRSA comprised a very low percentage of infections. Polymicrobial infections were rare. Initial thorough debridement and antibiotics are the mainstay of treatment.

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“…Some literature supports a selective screening protocol for high‐risk patients, such as those with frequent or recent hospitalizations. More recent information challenges this notion, with a large number of newly identified MRSA carriers not falling into a traditional high‐risk group 17 . It is unknown whether any of these risk factors are applicable to the population of patients needing Mohs surgery, but there is significant evidence that patients with prior MRSA infection or colonization are at greater risk for infectious complications, and we believe that these patients may be potential candidates to be screened and treated for continued colonization 13,18 …”

Section: Discussionmentioning

confidence: 99%

Preoperative Methicillin-Resistant Staphylococcus aureus Screening in Mohs Surgery Appears to Decrease Postoperative Infections

Cordova¹,

Grenier²,

Chang³

et al. 2010

Dermatologic Surgery

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The prevalence of methicillin resistant Staphylococus aureus in orthopaedics in a non-selective screening policy

Cited by 11 publications

References 20 publications

Can we reduce the number of MRSA screening site swabs in elective orthopedic patients?

Can we reduce the number of MRSA screening site swabs in elective orthopedic patients?

Incidence, Etiological Profile, and Treatment of Surgical Site Infections in Patients With Gunshot Injuries and Bomb Blast Injuries in Pakistan

Preoperative Methicillin-Resistant Staphylococcus aureus Screening in Mohs Surgery Appears to Decrease Postoperative Infections

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