title: Methicillin-resistant Staphylococcus aureus in orthopaedic surgery.
abstract: We prospectively studied the incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonisation and infection, the patterns and types of operation associated with MRSA acquisition in an orthopaedic and trauma unit in London, UK. Over the 12-month study period from January to December 2000, we found that 1.6% of the total admission was diagnosed to be either MRSA infected or colonised, with an average of three new MRSA cases detected per month. A significant proportion of patients (23%) were diagnosed within the first 48h of admission. Both hip joint surgery, especially emergency procedures for femoral neck fractures, and the presence of a wound presented higher risk of infection. The Intensive Care Unit (ICU) did not appear to be a significant source for intra-hospital dissemination among the orthopaedic patients. MRSA infection or colonisation contributed to an increased length of hospital stay; 88 days compared to 11 days on average for non-MRSA patients; 41% of the positive patients still carried MRSA on discharge. Our data show the importance of diagnosing MRSA in orthopaedic surgery and emphasises that understanding its epidemiology will be crucial to secure a decrease in the incidence of MRSA. Hand hygiene, patient screening, careful surveillance of infections and the prompt implementation of isolation policies, are essential components of control.
authors.affiliation: Department of Musculoskeletal Trauma, Imperial College School of Medicine, Charing Cross Campus, London, UK. cctai@doctors.net.uk
authors.forename: C C
authors.initials: CC
authors.lastname: Tai
authors.forename: A A
authors.initials: AA
authors.lastname: Nirvani
authors.forename: A
authors.initials: A
authors.lastname: Holmes
authors.forename: S P F
authors.initials: SP
authors.lastname: Hughes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D008131:London / Q000453:epidemiology; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D014193:Trauma Centers