Nasal methicillin-resistant Staphylococcus aureus colonization is associated with increased wound occurrence after major lower extremity amputation.
OBJECTIVE
Wound occurrence (WO) after major lower extremity amputation (MLEA) can be due to wound infection or sterile dehiscence. We sought to determine the association of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization and other patient factors with overall WO, WO due to wound infection, and WO due to sterile dehiscence.


METHODS
The medical records of all patients undergoing MLEA from August 1, 2011, to November 1, 2013, were reviewed. Demographic data, hemoglobin A1c level, albumin concentration, dialysis dependence, peripheral vascular disease (PVD), nasal MRSA colonization, and diabetes mellitus (DM) were examined as variables. The overall WO rate was determined, and the cause of WO was categorized as either a sterile dehiscence or a wound infection.


RESULTS
Eighty-three patients underwent 96 MLEAs during a 27-month period. The rates of overall WO, WO due to infection, and WO due to sterile dehiscence were 39%, 19%, and 19%, respectively (1% developed a traumatic wound). On univariate analysis, PVD, MRSA colonization, DM, and dialysis dependence were all associated with higher rates of overall WO (P < .05). On multivariate analysis, MRSA colonization was associated with higher rates of overall WO (P = .03) and WO due to wound infection (11% vs 45%; P < .01). DM and PVD were associated with higher rates of overall WO and WO due to sterile dehiscence on both univariate and multivariate analysis (P < .05).


CONCLUSIONS
Nasal MRSA colonization is associated with higher rates of overall WO and WO due to wound infection. DM and PVD are associated with higher rates of overall WO and WO due to sterile dehiscence but are not associated with WO due to wound infection. Further studies addressing the effect of nasal MRSA eradication on postoperative wound outcomes after MLEA are warranted.
Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, Portland, Ore; Operative Care Division, Portland VA Medical Center, Portland, Ore. Electronic address: azarbala@ohsu.edu.
Amir F
AF
Azarbal
Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, Portland, Ore.
Sheena
S
Harris
Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, Portland, Ore; Operative Care Division, Portland VA Medical Center, Portland, Ore.
Erica L
EL
Mitchell
Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, Portland, Ore; Operative Care Division, Portland VA Medical Center, Portland, Ore.
Timothy K
TK
Liem
Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, Portland, Ore; Operative Care Division, Portland VA Medical Center, Portland, Ore.
Gregory J
GJ
Landry
Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, Portland, Ore; Operative Care Division, Portland VA Medical Center, Portland, Ore.
Robert B
RB
McLafferty
Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, Portland, Ore; Operative Care Division, Portland VA Medical Center, Portland, Ore.
James
J
Edwards
Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, Portland, Ore; Operative Care Division, Portland VA Medical Center, Portland, Ore.
Greg L
GL
Moneta
D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D009666:Nose / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology*; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013530:Surgical Wound Infection / Q000382:microbiology*