title: Previous Methicillin-Resistant Staphylococcus aureus Infection Independent of Body Site Increases Odds of Surgical Site Infection after Ventral Hernia Repair.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus infections can be difficult to manage in ventral hernia repair (VHR). We aimed to determine whether a history of preoperative MRSA infection, regardless of site, confers increased odds of 30-day surgical site infection (SSI) after VHR.
  
  
  METHODS
  A retrospective cohort study of patients undergoing VHR with class I to III wounds between 2005 and 2012 was performed using Vanderbilt University Medical Center's Perioperative Data Warehouse. Preoperative MRSA status, site of infection, and 30-day SSI were determined. Univariate and multivariate analyses adjusting for confounding factors were performed to determine whether a history of MRSA infection was independently associated with SSIs.
  
  
  RESULTS
  A total of 768 VHR patients met inclusion criteria, of which 46% were women. There were 54 (7%) preoperative MRSA infections (MRSA positive); 15 (28%) soft tissue, 9 (17%) bloodstream, 4 (7%) pulmonary, 3 (6%) urinary, and 5 (9%) other. Overall SSI rate was 10% (n = 80), SSI rate in the MRSA-positive group was 33% (n = 18), compared with 9% (n = 62) in controls (p < 0.001). Multivariate analysis demonstrated that a history of MRSA infection significantly increased odds of 30-day SSI after VHR by 2.3 times (95% CI, 1.1-4.8; p = 0.035). Other factors associated with postoperative SSI were performance of myofascial release, increasing BMI, length of operation, open repair, and clean-contaminated wound classification.
  
  
  CONCLUSIONS
  A history of site-independent MRSA infection confers significantly increased odds of 30-day SSI after VHR. Additional investigation is needed to determine perioperative treatment regimens that might decrease odds of SSI in VHR, and optimal prosthetic types and techniques for this population.
authors.affiliation: Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: jousley11@email.mmc.edu.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ousley
authors.affiliation: Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Rebeccah B
authors.initials: RB
authors.lastname: Baucom
authors.affiliation: Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Stewart
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Phillips
authors.affiliation: Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Holzman
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.affiliation: Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Sharp
authors.affiliation: Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: William H
authors.initials: WH
authors.lastname: Nealon
authors.affiliation: Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D015999:Multivariate Analysis; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*