Focus on the prophylaxis, epidemiology and therapy of methicillin-resistant Staphylococcus aureus surgical site infections and a position paper on associated risk factors: the perspective of an Italian group of surgeons.
BACKGROUND
The aim of this research was to study the epidemiology, microbiology, prophylaxis, and antibiotic therapy of surgical site infections (SSIs), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), and identify the risk factors for these infections. In Italy SSIs occur in about 5 % of all surgical procedures. They are predominantly caused by staphylococci, and 30 % of them are diagnosed after discharge. In every surgical specialty there are specific procedures more associated with SSIs.


METHODS
The authors conducted a systematic review of the literature on SSIs, especially MRSA infections, and used the Delphi method to identify risk factors for these resistant infections.


RESULTS
Risk factors associated with MRSA SSIs identified by the Delphi method were: patients from long-term care facilities, recent hospitalization (within the preceding 30 days), Charlson score > 5 points, chronic obstructive pulmonary disease and thoracic surgery, antibiotic therapy with beta-lactams (especially cephalosporins and carbapenem) and/or quinolones in the preceding 30 days, age 75 years or older, current duration of hospitalization >16 days, and surgery with prothesis implantation. Protective factors were adequate antibiotic prophylaxis, laparoscopic surgery and the presence of an active, in-hospital surveillance program for the control of infections. MRSA therapy, especially with agents that enable the patient's rapid discharge from hospital is described.


CONCLUSIONS
The prevention, identification and treatment of SSIs, especially those caused by MRSA, should be implemented in surgical units in order to improve clinical and economic outcomes.
Istituto Clinica Chirurgica, Divisione Chirurgia Generale e Trapianti d'Organo, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
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G
Sganga
U.O. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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C
Tascini
U.O. Medicina d'Urgenza Universitaria, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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E
Sozio
Chirurgia generale Ospedale Sant'Eugenio di Roma, Rome, Italy.
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M
Carlini
Dipartimento di Chirurgia Università La Sapienza, Policlinico Umberto I, Rome, Italy.
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P
Chirletti
UOC Chirurgia di Urgenza Ospedale San Filippo Neri, Rome, Italy.
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F
Cortese
Dipartimento di Chirurgia Generale e Trapianti d'Organo, UOC Chirurgia Vascolare, Università La Sapienza, Policlinico Umberto I, Rome, Italy.
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R
Gattuso
Istituto Patologia Chirurgia, Unità Operativa Complessa Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
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P
Granone
Ortopedia e Traumatologia dell'Ospedale S. Gennaro ASL Napoli 1 Centro, Naples, Italy.
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C
Pempinello
U.O Chirurgia Generale Ospedale di Macerata, Macerata, Italy.
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M
Sartelli
Master Sepsi in Chirurgia, Università Cattolica, Rome, Italy.
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Colizza
Dalbavancin; MRSA; Surgical site infection