Nasal colonization of methicillin-resistant
Staphylococcus aureus was associated with an increased incidence of
surgical site infections among patients undergoing major gastrointestinal
surgery, according to research presented at Digestive Disease Week in San
Diego.
“Surgical site infections involving MRSA are
associated with longer hospital stays, increased mortality and significant
increases in health care costs,” Harry T. Papaconstantinou, MD,
chief of colorectal surgery at Scott and White Memorial Hospital in Temple,
Texas, said during a press briefing. “Admission screening for MRSA has
been initiated by many hospitals to identify and isolate patients who are
colonized with MRSA.”
A team of researchers, led by Papaconstantinou, began
universal nasal swab testing on patients undergoing major gastrointestinal
surgery. From December 2007 to August 2009, 1,137 patients underwent
gastrointestinal surgery and nasal swab testing. Of the patients tested, 6.7%
had MRSA, 14.7% had methicillin-sensitive S. aureus and 78.9% tested
negative.
After surgery, 101 patients developed a surgical site
infection. The MRSA group had a higher rate of surgical site infections: 13.7%
vs. 9.4% for those with negative swabs vs. 4.2% for those with MSSA.
Harry T. Papaconstantinou
The researchers obtained wound culture results from 92
of the 101 patients with surgical site infections. Those with positive MRSA
nasal swabs had a higher rate of MRSA positive wound cultures: 70% vs. 8.5% for
those without positive MRSA nasal swabs.
The median length of hospital days was 12.5 days among
those with MRSA — 4 days longer than those without MRSA. Presence of a
surgical site infection increased length of stay from 6.2 days to 15.7 days,
but there was no difference in length of stay with surgical site infection
between the groups.
“The take-home message is that a positive MRSA
nasal swab test is a strong predictor that MRSA-related surgical site infection
may occur in patients undergoing major gastrointestinal surgery,”
Papaconstantinou said. “It may be beneficial to preoperatively screen and
decolonize these patients to reduce the incidence of these infections and to
improve patient outcomes following operations.”
References:
- Papaconstantinou H. #374. Presented at: Digestive Disease Week
2012; May 19-22, 2012; San Diego.
Disclosures:
- Dr. Papaconstantinou reports no relevant financial
disclosures.