MRSA infection in orthopaedic trauma surgery a population study over 18 years in a district hospital. Mr Sajjad Athar,FRCS(Trauma & Orth) Specialist Doctor, Department of Trauma and Orthopaedics Mr Ilias Galanapoulos, Specialist Doctor, Department of Trauma and Orthopaedics
Mr Neil Ashwood BSc FRCS (Orth) Ed, Consultant, Department of Trauma and Orthopaedics, Queens Hospital, Burton upon Trent Corresponding author: Mr Sajjad Athar, Queens Hospital,Burton upon Trent, Staffordshire Abstract
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RSA infection in orthopaedics trauma surgery increases hospital stay and the need for further wound closure therapies. A prospective database of identified 163 cases of MRSA infection from 1994 when the first case occurred until the end of June 2013 in orthopaedics with 36 cases occurring in elective surgery and 14 in diabetic foot cases. MRSA occurred in 0.0012% of all our admissions trauma cases and 0.02% of hip fractures. The majority of MRSA infections occurred in 78 with hip fractures, 25 following lower limb fractures and 10 following upper limb surgery. Mortality was not increased in comparison to non-infected cases but having an MRSA infection in hospital delayed the discharge of the patient by an average of 11.2 days. Further
Introduction Since the 1980s, methicillin-resistant Staphylococcus aureus (MRSA) had been isolated in hospitals and within the community. This led to a peak in cases in 2009 locally. Methicillin resistance and infections caused by other antibiotic resistant organisms represent a growing problem and an ever increasing challenge for health-care professionals. Patients are now aware of these types of organisms which are popularly termed hospital ‘superbugs’. It is perceived by the public that the development of antibiotic resistant infections is preventable through improved hygiene and other measures. Indeed the rate of MRSA infection has been quoted on national television as being as high as one in seventy five following hip replacement with inferred disastrous consequences. The first methicillin-resistant Staphylococcus aureus (MRSA) case at Queen’s Hospital Burton was in 1993 and a year later the first positive swab was isolated in orthopaedics.
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The Physician
surgery was required in 43 (38%) of the 113 cases to control the effects of the infection at the surgical site with 12 (9%) requiring revision of fixation. The chance of further surgery was 30% higher than for trauma cases infected with gram negative or other gram positive organisms with a similar revision rate. A third of cases required re-admission in comparison to 22% in cases with other infections. The presence of multiple co-morbidities appeared in those requiring further interventions especially diabetes, immunosurpression and smoking. MRSA screening was introduced in 2009 showing that 79% of cases already had MRSA colonisation with 69% of patients coming from residential care. Whilst the peak incidence appears to have been reached following the introduction of screening and regular deep cleaning MRSA infection continues to lead to significant morbidity in orthopaedic trauma cases. Eradication of chronic infections from residential care institutions may help reduce the risk further of elderly frail patients having a poor outcome.
Methicillin-resistant staphylococcus aureus (MRSA) infection following orthopaedic surgery has been widely reported as a cause of increased length of stay and wound problems particularly in proximal femoral fractures as outlined by Nixon and co-authors (1) in 2006 although the mortality rate was not affected. Shams and Rapp(19), from Lexington in America in 2004 suggest that orthopaedic implants and fracture fixation devices colonised by MRSA are difficult to treat. Preoperative eradication of MRSA colonisation was recommended in the five percent of patients found to be affected on screening in order to decrease the incidence of postoperative infections. Hassan and coauthors(24) in 2008 found for orthopaedic patients that colonisation was not confined to high risk groups lending support to the need for widespread screening to prevent morbidity and mortality. Johnson and Johnston(16) in 1998 retrospectively looked at the outcome of patients who sustained
Vol 3 Issue1 June 2015