title: Risk factors associated with methicillin-resistant staphylococcal wound infection after spinal surgery.
abstract: We used the data from a retrospective case controlled study to identify risk factors for methicillin-resistant staphylococcal wound infection after spinal surgery. Thirty-five cases and 35 uninfected control patients were matched for indication for initial surgery and approximate operative date. Preoperative, intraoperative, and postoperative risk factors were examined. At our institution between 1989 and 1995, 35 adult patients developed spinal wound infection requiring operative debridement; 16 infections were caused by methicillin-resistant staphylococci (MRS). Significant risk factors for MRS infection were lymphopenia, history of chronic infections, alcohol abuse, recent hospitalization, and prolonged postoperative wound drainage. Patients with MRS infections were also somewhat less likely to have received vancomycin prophylaxis. In contrast, the only factor associated with infection caused by other pathogens was alcohol abuse. A number of preoperative risk factors were significantly associated with subsequent MRS spinal wound infection. Chemoprophylaxis with vancomycin should be targeted to patients at increased risk, because overuse may promote the emergence of vancomycin-resistant pathogens.
authors.affiliation: Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: J
authors.initials: J
authors.lastname: Klekamp
authors.forename: D M
authors.initials: DM
authors.lastname: Spengler
authors.forename: M J
authors.initials: MJ
authors.lastname: McNamara
authors.forename: D W
authors.initials: DW
authors.lastname: Haas
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D016022:Case-Control Studies; D006801:Humans; D008712:Methicillin / Q000627:therapeutic use*; D016106:Methicillin Resistance; D015999:Multivariate Analysis; D010406:Penicillins / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D013116:Spinal Cord / Q000601:surgery; D013131:Spine / Q000601:surgery*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000601:surgery; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000601:surgery; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D014640:Vancomycin; D008712:Methicillin