MRSA in lower limb amputation and the role of antibiotic prophylaxis.
OBJECTIVE
Methicillin Resistant Staphylococcus Aureus (MRSA) colonisation is reported in 3-20% of vascular patients. Many develop infective complications. MRSA is associated with poor prognosis. Aim of the study is to assess MRSA in lower limb amputation and efficacy of antibiotic prophylaxis.


METHODS
Prospective study of lower limb amputation. MRSA screen and wound swabs were taken at operation. Antibiotic prophylaxis included teicoplanin (400 mg) 1 dose at operation.


RESULTS
Twenty-five patients underwent 33 primary amputations. At operation 15 legs (45%) were colonised with MRSA and 18 legs (58%) had active wound infection; MRSA (4) and other (14). Following surgery 3 patients died. Twenty-two legs (76%) had primary healing. Infection developed in 7 stumps (24%), MRSA (5) and Pseudomonas (2). Stump infection increased time to wound healing (p<0.0001). MRSA stump infection increased revision amputation (p=0.009) and duration of hospital stay (p<0.0074). MRSA wound infection at operation increased the risk of MRSA stump infection (p=0.007). Non-MRSA wound infection at operation was not associated with a worse outcome. No patient colonised with MRSA at operation developed postoperative MRSA stump infection.


CONCLUSIONS
MRSA is more prevalent that previously reported. MRSA infection has a poor prognosis. Prophylaxis may be effective for patients colonised with MRSA.
Richards
T
T
Vascular Unit, Department of Surgery, Royal Berkshire Hospital, London, UK. toby.richards@virgin.net
Pittathankel
A A
AA
Pursell
R
R
Magee
T R
TR
Galland
R B
RB
D000368:Aged; D000671:Amputation, Surgical; D000672:Amputation Stumps / Q000382:microbiology*; D019072:Antibiotic Prophylaxis; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D007902:Length of Stay; D008297:Male; D016106:Methicillin Resistance; D011379:Prognosis; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects*; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000517:prevention & control; D017334:Teicoplanin / Q000627:therapeutic use; D014945:Wound Healing
D017334:Teicoplanin