Is it possible to predict outcome in MRSA positive patients undergoing arterial reconstruction?
OBJECTIVE
There is an increasing incidence of methicillin resistant Staphylococcus aureus (MRSA) following vascular surgery, which is associated with poor outcome. The risk factors and timing for MRSA acquisition have been established. We attempt to establish predictors of outcome in MRSA positive patients undergoing arterial reconstruction.


METHODS
Eighty-five MRSA positive patients who underwent arterial surgery were grouped according to outcome: good outcome group (successful revascularisation) or poor outcome group (major limb amputation or death). Seven variables were compared: age, gender, renal function, co-morbidity, positive swab site, incision site and second revascularisation surgery.


RESULTS
Increased MRSA incidence from 1.1% to 4.6% of total admissions was highlighted over a 6 year period. When good (n=40) and poor (n=45) outcome groups were compared, no statistically significant differences were identified for the variables listed above, but a second revascularisation operation was 3 times more likely to be associated with poor outcome (P=0.09). Categorising gender and age groups suggests that male gender and age over 75 years was more likely to be associated with poor outcome (odds ratio 0.77). The results also suggest that patients having surgery involving a groin incision do worse than those who do not. One year survival of MRSA positive patients who had successful revascularisation was 90% and a significant number had MRSA eradicated.


CONCLUSIONS
Although this study was unable to identify statistically significant predictors of outcome in patients with MRSA undergoing arterial reconstruction, almost half had a positive outcome. An aggressive detection and eradication policy is clearly indicated.
Malde
D J
DJ
Department of Vascular Surgery, South Manchester University Hospital, Manchester, UK. drdeepmalde@yahoo.com
Hardern
L
L
Welch
M
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005263:Femoral Artery / Q000382:microbiology / Q000601:surgery*; D005500:Follow-Up Studies; D006119:Groin / Q000098:blood supply / Q000601:surgery; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011150:Popliteal Artery / Q000382:microbiology / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013203:Staphylococcal Infections / Q000382:microbiology / Q000601:surgery*; D013211:Staphylococcus aureus; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods