title: MRSA colonisation and subsequent risk of infection despite effective eradication in orthopaedic elective surgery.
abstract: The objective of this study was to determine the effectiveness of screening and successful treatment of methicillin-resistant Staphylococcus aureus (MRSA) colonisation in elective orthopaedic patients on the subsequent risk of developing a surgical site infection (SSI) with MRSA. We screened 5933 elective orthopaedic in-patients for MRSA at pre-operative assessment. Of these, 108 (1.8%) were colonised with MRSA and 90 subsequently underwent surgery. Despite effective eradication therapy, six of these (6.7%) had an SSI within one year of surgery. Among these infections, deep sepsis occurred in four cases (4.4%) and superficial infection in two (2.2%). The responsible organism in four of the six cases was MRSA. Further analysis showed that patients undergoing surgery for joint replacement of the lower limb were at significantly increased risk of an SSI if previously colonised with MRSA. We conclude that previously MRSA-colonised patients undergoing elective surgery are at an increased risk of an SSI compared with other elective patients, and that this risk is significant for those undergoing joint replacement of the lower limb. Furthermore, when an infection occurs, it is likely to be due to MRSA.
authors.affiliation: Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
authors.forename: E
authors.initials: E
authors.lastname: Murphy
authors.forename: S J
authors.initials: SJ
authors.lastname: Spencer
authors.forename: D
authors.initials: D
authors.lastname: Young
authors.forename: B
authors.initials: B
authors.lastname: Jones
authors.forename: M J G
authors.initials: MJ
authors.lastname: Blyth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D019990:Perioperative Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents