Prevalence of MRSA in emergency and elective patients admitted to a vascular surgical unit: implications for antibiotic prophylaxis.
OBJECTIVE



METHODS
200 consecutive emergency/transfer and 150 consecutive elective patients admitted between April 2004 and January 2005, were studied. Data was obtained from departmental Morbidity and Mortality records and the computerised laboratory medicine information system.


RESULTS
261 (75%) of the 350 patients were screened for MRSA on admission (target 100%). The proportions of emergency/transfer and elective patients screened were similar (78% and 72% respectively). The prevalence of MRSA carriage detected by admission screening in emergency/transfer patients 30/153 (20%), was significantly higher (p<0.0001) than in elective patients 2/108 (2%). A simple decision analysis model suggests that gentamicin should be used when the prevalence of MRSA reaches 10% and vancomycin when the prevalence reaches 50%.


CONCLUSIONS
The high prevalence of MRSA colonisation in emergency/transfer patients has important implications for pre-operative antibiotic prophylaxis.
Muralidhar
B
B
Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, OX3 9DU, UK. bm239@cam.ac.uk
Anwar
S M
SM
Handa
A I
AI
Peto
T E A
TE
Bowler
I C J W
IC
D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D002353:Carrier State / Q000175:diagnosis; D003661:Decision Support Techniques; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010343:Patient Admission; D015995:Prevalence; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects; D014656:Vascular Surgical Procedures