Methicillin resistant Staphylococcus aureus in patients undergoing major amputation.
OBJECTIVE
To examine the impact of MRSA infection on patients undergoing major amputation.


METHODS
District General Hospital.


METHODS
Patients having had major amputation and positive MRSA cultures January 1995-December 1999 were included. Outcome was compared with a randomly chosen group of patients having major amputation but no positive MRSA culture from the same time period.


RESULTS
overall 21% of patients undergoing amputation were MRSA positive. Some 28 patients (30 amputations) with MRSA positive cultures were compared with 44 patients (54 amputations) who did not have positive cultures for MRSA. MRSA was isolated from the wound in 17 of 30 amputations. More patients in the control group had a below knee amputation (38 of 54 compared with 12 of 30, p<0.02). Mortality in MRSA positive patients was higher than controls, (12 of 28, 43%, versus 4 of 44, 9%, p<0.01). Primary healing was achieved in only 4 of 17 (24%) amputations where MRSA was isolated from the wound. This compared with 31 of 54 (57%) controls (p<0.05). Delayed healing due to chronic infection was also more likely in MRSA positive patients (p<0.01).


CONCLUSIONS
In view of the high morbidity and mortality in patients with MRSA positive isolates specific antibiotic prophylaxis against MRSA should be considered in patients undergoing major amputation.
Grimble
S A
SA
Department of Surgery, Royal Berkshire Hospital, Reading, UK.
Magee
T R
TR
Galland
R B
RB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects* / Q000379:methods*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007866:Leg; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D015996:Survival Rate; D016896:Treatment Outcome; D014945:Wound Healing