Sustained Reduction in Methicillin-Resistant Staphylococcus aureus Wound Infections After Cardiothoracic Surgery.
Summary of "Sustained Reduction in Methicillin-Resistant Staphylococcus aureus Wound Infections After Cardiothoracic Surgery."
BACKGROUND:
Methicillin-resistant Staphylococcus aureus (MRSA) wound infections after cardiac surgery have increased in recent years and carry significant morbidity and mortality. In our hospital, MRSA accounted for 56% of postoperative infections.
METHODS:
Postoperative wound infection rates were compared for the 3 years before (baseline period) and after (intervention period) introduction of a comprehensive MRSA intervention program. The intervention included preoperative screening for MRSA colonization, administration of intravenous vancomycin prophylaxis for identified carriers, administration of intranasal mupirocin calcium ointment to all patients regardless of colonization status for 5 days beginning the day before surgery, and application of mupirocin to chest tube sites at the time of removal.
RESULTS:
Postoperative MRSA wound infections decreased by 93% (32 infections per 2767 cases in the baseline period vs 2 infections per 2496 cases in the intervention period; relative risk, 0.069; P < .001). Overall wound infection rates decreased from 2.1% to 0.8% (59 infections per 2769 cases vs 20 infections per 2496 cases; P < .001). During the intervention period, there was no change in the number of MRSA infections after noncardiac surgery.
CONCLUSION:
This MRSA intervention program, in which all patients receive intranasal mupirocin and patients colonized with MRSA receive vancomycin prophylaxis, has resulted in a near-complete and sustained elimination of MRSA wound infections after cardiac surgery.
Affiliation
University of Rochester School of Medicine and Dentistry and Rochester General Hospital, Rochester, New York (Dr Walsh); Departments of Infection Prevention (Ms Greene) and Cardiothoracic Surgery (Dr Kirshner), Rochester General Hospital; and Department o
Journal Details
This article was published in the following journal.
Name: Archives of internal medicine
ISSN: 1538-3679
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20837818
- DOI: http://dx.doi.org/10.1001/archinternmed.2010.326
Medical and Biotech [MESH] Definitions
Methicillin-resistant Staphylococcus Aureus
A strain of Staphylococcus aureus that is non-susceptible to the action of METHICILLIN. The mechanism of resistance usually involves modification of normal or the presence of acquired PENICILLIN BINDING PROTEINS.
Pneumonia, Staphylococcal
Pneumonia caused by infections with bacteria of the genus STAPHYLOCOCCUS, usually with STAPHYLOCOCCUS AUREUS.
Staphylococcus Hominis
A species of STAPHYLOCOCCUS similar to STAPHYLOCOCCUS HAEMOLYTICUS, but containing different esterases. The subspecies Staphylococcus hominis novobiosepticus is highly virulent and novobiocin resistant.
Lysostaphin
A 25-kDa peptidase produced by Staphylococcus simulans which cleaves a glycine-glcyine bond unique to an inter-peptide cross-bridge of the STAPHYLOCOCCUS AUREUS cell wall. EC 3.4.24.75.
Staphylococcus Aureus
Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications.
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