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Surgical patients with methicillin resistant staphylococcus aureus infection: an analysis of outcome using P-POSSUM
K V Menon1, M S Whiteley, P Burden
1Department of Surgery, Royal Berkshire Hospital, Reading, U.K.
Abstract:
The significance of MRSA infection in surgical patients was studied using the P-POSSUM scoring system. All surgical patients undergoing operation between 1/10/96 and 30/09/97 were prospectively scored using P-POSSUM. A subset of these patients with MRSA infection was analysed using P-POSSUM predicted mortality. Physiological and operative severity scores were compared with non-MRSA surgical patients and length of hospital stay with P-POSSUM matched non-MRSA controls. Thirty of the 1,132 patients were MRSA positive and of these five died, giving a P-POSSUM observed/expected deaths ratio of 1.7 (not significant; 95% CI -0.24 to 0.10). The P-POSSUM physiology score of 30 MRSA positive patients, compared with the non-MRSA group (n = 1102), was significantly more severe (20.9 v/s 17.4; 95% CI 1.09 to 5.95) as was the operative severity score (15.6 v/s 9.2; 95% CI 4.40 to 8.42). The length of stay for surviving MRSA positive patients was significantly longer than P-POSSUM matched controls. MRSA infection in surgical patients does not increase mortality. However, patients who contract MRSA infection are more debilitated and have undergone a greater surgical insult.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) infection in surgical patients does not increase mortality. However, MRSA-positive patients are more debilitated and experience longer hospital stays.
Area of Science:
- Surgical Infections
- Epidemiology
- Patient Outcomes
Background:
- Surgical site infections (SSIs) pose a significant threat to patient recovery.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen in healthcare settings.
- Understanding the impact of MRSA on surgical patient outcomes is crucial for effective management.
Purpose of the Study:
- To investigate the mortality and morbidity associated with MRSA infection in surgical patients.
- To compare the severity of illness and length of stay between MRSA-positive and MRSA-negative surgical patients.
- To evaluate the predictive accuracy of the P-POSSUM scoring system for MRSA-infected surgical patients.
Main Methods:
- Prospective cohort study of 1,132 surgical patients between 1/10/96 and 30/09/97.
- Utilized the P-POSSUM scoring system to assess physiological and operative severity.
- Compared outcomes (mortality, length of stay) between MRSA-positive (n=30) and MRSA-negative (n=1102) patients.
Main Results:
- MRSA infection did not significantly increase observed mortality (P-POSSUM O/E ratio = 1.7).
- MRSA-positive patients had significantly higher P-POSSUM physiology (20.9 vs 17.4) and operative severity scores (15.6 vs 9.2).
- Surviving MRSA-positive patients experienced significantly longer hospital stays compared to matched controls.
Conclusions:
- MRSA infection in surgical patients is not associated with increased mortality.
- Patients contracting MRSA are generally more debilitated and undergo more severe surgical procedures.
- MRSA infection leads to increased resource utilization, primarily due to prolonged hospital stays.