SLR - June 2012 - Sarah Newey
Reference: Eseon, K., Middleton, S., Eseonu, C. (2012) A retrospective study of risk factors for poor outcomes in methicillin-resistant staphylococcus aureus (MRSA) infection in surgical patients. Journal of Orthopaedic Surgery and Research 2011, 6:25
Scientific Literature Review
Reviewed by: Sarah Newey, DPM
Residency Program: OCPM & University Hospital Richmond Heights Medical Center
Podiatric Relevance:
Methicillin-resistant Staphlococcus aureus (MRSA) infections have become increasingly common in podiatric patients beginning with minor foot problems, injury, or surgery. The purpose of this review is to recognize the significant factors that identify surgical patients most susceptible to MRSA infections.
Methods:
This was a retrospective study of the rates and outcomes of MRSA infection in orthopedic trauma over an 11 year period. A randomized sample of patients who developed post-operative MRSA was used for analysis. This sample included 15 percent of all cases over this period. Patients were grouped into categories for age and time from original injury. Data was analyzed using both chi-squared and Fisher’s exact tests.
Results:
This study looked at 61 orthopaedic trauma admissions from January 1998 to March 2009. It focused on the final outcome and significance of selected criteria, including immunocompromised status of the patient, pre-admission residence, length of stay, gender and prophylaxis. The study found that 58 percent of immunocompromised patients had adverse outcomes, compared to 30 percent of patients without impaired immunity. When looking at pre-admission residence, 32 percent of patients admitted from home had adverse outcomes and 40 percent of patients admitted from an institutional setting. Length of stay was a significant factor in this study with 62 percent of patients with a stay longer than 30 days experienced adverse outcomes and 24 percent who stayed less than 30 days. Gender was not found to play a factor in the outcomes in this study. It was also found that there was no significant relationship between antibiotic prophylaxis or site of infection and the outcome.
Conclusions:
This study showed that length of stay and preadmission residence were found to be the most significant factors associated with MRSA infections. Identifying high risk patients using the risk factors acknowledged in the results of this study could be used for targeted prophylaxis and early therapeutic antibiotic treatment.