title: Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control.
abstract: We examined the rates of infection and colonisation by methicillin-resistant Staphylococcus aureus (MRSA) between January 2003 and May 2004 in order to assess the impact of the introduction of an MRSA policy in October 2003, which required all admissions to be screened. Emergency admissions were treated prophylactically and elective beds ring-fenced. A total of 5,594 admissions were cross-referenced with 22,810 microbiology results. The morbidity, mortality and cost of managing MRSA-carrying patients, with a proximal fracture of the femur were compared, in relation to age, gender, American Society of Anaesthesiologists grade and residential status, with a group of matched controls who were MRSA-negative. In 2004, we screened 1795 of 1,796 elective admissions and MRSA was found in 23 (1.3%). We also screened 1,122 of 1,447 trauma admissions and 43 (3.8%) were carrying MRSA. All ten ward transfers were screened and four (40%) were carriers (all p < 0.001). The incidence of MRSA in trauma patients increased by 2.6% per week of inpatient stay (r = 0.97, p < 0.001). MRSA developed in 2.9% of trauma and 0.2% of elective patients during that admission (p < 0.001). The implementation of the MRSA policy reduced the incidence of MRSA infection by 56% in trauma patients (1.57% in 2003 (17 of 1,084) to 0.69% in 2004 (10 of 1,447), p = 0.035). Infection with MRSA in elective patients was reduced by 70% (0.56% in 2003 (7 of 1,257) to 0.17% in 2004 (3 of 1,806), p = 0.06). The cost of preventing one MRSA infection was 3,200 pounds. Although colonisation by MRSA did not affect the mortality rate, infection by MRSA more than doubled it. Patients with proximal fractures of the femur infected with MRSA remained in hospital for 50 extra days, had 19 more days of vancomycin treatment and 26 more days of vacuum-assisted closure therapy than the matched controls. These additional costs equated to 13,972 pounds per patient. From this experience we have been able to describe the epidemiology of MRSA, assess the impact of infection-control measures on MRSA infection rates and determine the morbidity, mortality and economic cost of MRSA carriage on trauma and elective orthopaedic wards.
authors.affiliation: Department of Orthopaedics, Glenfield Hospital, Leicester LE3 9QP, UK. mfnixon@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Nixon
authors.forename: B
authors.initials: B
authors.lastname: Jackson
authors.forename: P
authors.initials: P
authors.lastname: Varghese
authors.forename: D
authors.initials: D
authors.lastname: Jenkins
authors.forename: G
authors.initials: G
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology; D004630:Emergencies / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D005264:Femoral Fractures / Q000382:microbiology / Q000601:surgery; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D016106:Methicillin Resistance; D008875:Middle Aged; D019637:Orthopedic Procedures; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D014640:Vancomycin / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin