title: Impact of methicillin-resistant Staphylococcus aureus infection on outcome after esophagectomy.
abstract: BACKGROUND
  Infection with methicillin-resistant Staphylococcus aureus (MRSA) has reached endemic proportions in the United Kingdom. The aim of the present study was to determine the frequency of MRSA infection in patients undergoing esophagectomy and to report its impact on patient outcome.
  
  
  METHODS
  The study population was 98 patients undergoing esophagectomy for carcinoma during the years 1998-2004. Patient information was collected prospectively and entered into a computerized database and analyzed retrospectively by univariate and multivariate analysis.
  
  
  RESULTS
  Overall, 20 of the 98 patients (20%) developed infection with MRSA after esophagectomy. Patients who developed MRSA infection had greater levels of postoperative morbidity, longer intensive care unit (ICU) stays (median 2 days versus 1 day, P = 0.005) and hospital stays (21 days versus 16 days, P < 0.001) compared to those who did not develop infection. Multivariate analysis identified preoperative chemotherapy (P = 0.006) and readmission to the ICU (P = 0.007) as significant risk factors with MRSA infection. Overall, 17 of 46 patients (37%) who received neoadjuvant chemotherapy developed MRSA infection, compared to 3 of 52 (6%) who did not receive this treatment (P = 0.0001).
  
  
  CONCLUSIONS
  Overall, one in five patients undergoing esophagectomy developed MRSA infection, with those patients who received neoadjuvant chemotherapy identified as being at greatest risk of this complication. This is an alarming finding, as neoadjuvant chemotherapy is the standard of care for patients with esophageal carcinoma in the United Kingdom.
authors.affiliation: Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4X, United Kingdom. david.bowrey@uhl-tr.nhs.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: Bowrey
authors.forename: Martyn D
authors.initials: MD
authors.lastname: Evans
authors.forename: Geoffrey W B
authors.initials: GW
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology*; D004935:Esophageal Diseases / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus; D016896:Treatment Outcome; D006113:United Kingdom