title: Risk factors for postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus.
abstract: Risk factors for developing postoperative mediastinitis (POM) due to methicillin-resistant Staphylococcus aureus (MRSA) were analyzed in a case-case control study of patients who underwent median sternotomy during the period from 1994 through 2000. Three patient groups were studied. The first consisted of 64 patients with POM due to MRSA; the second consisted of 79 patients with POM due to methicillin-susceptible S. aureus (MSSA); and the third consisted of 80 uninfected control patients. In multivariable analysis, patients who were diabetic (adjusted OR, 2.86; 95% CI, 1.22-6.70), female (OR, 2.70; 95% CI, 1.25-5.88), and >70 years old (OR, 3.43; 95% CI, 1.53-7.71) were more likely to develop POM due to MRSA. In contrast, the only independent risk factor associated with POM due to MSSA was obesity (OR, 2.49; 95% CI, 1.25-4.96). Antimicrobial prophylaxis consisted primarily of cephalosporin antibiotics (administered to 97% of the patients). Changes in perioperative antimicrobial prophylaxis, in addition to other interventions, should be considered for prevention of POM due to MRSA in targeted, high-risk populations.
authors.affiliation: Duke University Medical Center, Durham, North Carolina 27710, USA. dodds002@mc.duke.edu
authors.forename: E S
authors.initials: ES
authors.lastname: Dodds Ashley
authors.forename: D N
authors.initials: DN
authors.lastname: Carroll
authors.forename: J J
authors.initials: JJ
authors.lastname: Engemann
authors.forename: A D
authors.initials: AD
authors.lastname: Harris
authors.forename: V G
authors.initials: VG
authors.lastname: Fowler
authors.forename: D J
authors.initials: DJ
authors.lastname: Sexton
authors.forename: K S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002511:Cephalosporins / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008480:Mediastinitis / Q000382:microbiology* / Q000517:prevention & control; D008712:Methicillin / Q000378:metabolism* / Q000627:therapeutic use*; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D012737:Sex Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000378:metabolism* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D008712:Methicillin