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Methicillin-resistant Staphylococcus aureus as a causative agent of postoperative intra-abdominal infection: relation
1Department of Anesthesiology and Intensive Care, Bichat University Hospital, 75018 Paris, France. lfierobe.bichat@invivo.edu
Abstract:
In the surgical intensive care unit of a university hospital, we investigated the frequency of and the risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) during postoperative intra-abdominal infection (pIAI). We conducted a prospective MRSA nasal screening and case evaluation for 17 months among 73 consecutive patients with having pIAI. MRSA pIAI was diagnosed when MRSA was obtained from culture of intraperitoneal fluids. The identity of nasal and peritoneal MRSA strains was assessed by genomic analysis. Twelve patients had MRSA pIAI, representing 21% of all MRSA infections acquired by the 73 patients. An organ system failure score of >/=1 and MRSA nasal carriage prior to pIAI were the independent risk factors for acquisition of MRSA pIAI. Patients with MRSA pIAI had a longer intensive care unit stay and more reoperations than did those free of MRSA pIAI. We conclude that MRSA may be a causative pathogen in pIAI and may be related to nasal colonization.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) can cause postoperative intra-abdominal infections (pIAI). Prior MRSA nasal carriage and organ failure are key risk factors for developing MRSA pIAI.
Area of Science:
- Infectious Diseases
- Surgical Critical Care
- Microbiology
Background:
- Postoperative intra-abdominal infections (pIAI) are a significant concern in surgical intensive care units.
- The role of methicillin-resistant Staphylococcus aureus (MRSA) as a causative pathogen in pIAI requires further investigation.
Purpose of the Study:
- To determine the frequency of MRSA acquisition in patients with pIAI.
- To identify risk factors associated with MRSA acquisition in this patient population.
Main Methods:
- Prospective study involving MRSA nasal screening and case evaluation over 17 months.
- Diagnosis of MRSA pIAI based on MRSA isolation from intraperitoneal fluid cultures.
- Genomic analysis to assess the identity of MRSA strains from nasal and peritoneal sites.
Main Results:
- Twelve out of 73 patients (21%) developed MRSA pIAI.
- Independent risk factors identified were an organ system failure score ≥1 and pre-existing MRSA nasal carriage.
- Patients with MRSA pIAI experienced longer intensive care unit stays and required more reoperations.
Conclusions:
- MRSA can be a causative pathogen in postoperative intra-abdominal infections.
- Nasal colonization with MRSA is a significant risk factor for developing MRSA pIAI.
- Early identification and management of MRSA colonization may be crucial in preventing MRSA pIAI.