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Poststernotomy mediastinitis due to Staphylococcus aureus: comparison of methicillin-resistant and
A Mekontso-Dessap1, M Kirsch, C Brun-Buisson
1Service de Chirurgie Thoracique et Cardiovasculaire, Centre Hospitalo-Universitaire Henri Mondor, Créteil, France.
Abstract:
The objective of the study was to compare the outcome of poststernotomy mediastinitis (PSM) caused by methicillin-resistant and methicillin-susceptible Staphylococcus aureus (MRSA and MSSA, respectively). Hospital records of 41 patients with S. aureus PSM who were all treated by closed drainage from 1 April 1996 through 1 February 2000 were reviewed. PSM was caused by MRSA in 15 patients and by MSSA in 26. Follow-up (+/-SD) averaged 12.5+/-14.0 months per patient. Both groups had similar perioperative characteristics. Patients with MRSA PSM had a significantly lower actuarial survival rate than did patients with MSSA PSM (60.0%+/-12.6%, 52.5%+/-3.4%, and 26.3%+/-19.7% versus 84.6%+/-7.1%, 79.0%+/-8.6%, and 79.0%+/-8.65 at 1 month, and at 1 and 3 years, respectively; values are +/- SD; P=.04). PSM-related death and treatment failure were significantly higher in the MRSA group than in the MSSA group (P=.03 and.02, respectively). Logistic regression analysis revealed that MRSA was the only independent risk factor for overall mortality. In conclusion, the clinical outcome of PSM caused by MRSA is poorer than that caused by MSSA.
Insights
Poststernotomy mediastinitis (PSM) caused by methicillin-resistant Staphylococcus aureus (MRSA) leads to significantly poorer outcomes compared to methicillin-susceptible Staphylococcus aureus (MSSA). MRSA is an independent risk factor for mortality in PSM patients.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Cardiothoracic Surgery
Background:
- Poststernotomy mediastinitis (PSM) is a serious complication following cardiac surgery.
- Staphylococcus aureus is a common causative agent of PSM.
- Distinguishing outcomes between methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) strains is crucial for treatment strategies.
Purpose of the Study:
- To compare the clinical outcomes of PSM caused by MRSA versus MSSA.
- To identify risk factors associated with mortality in S. aureus PSM.
Main Methods:
- Retrospective review of 41 patients with S. aureus PSM treated with closed drainage.
- Comparison of perioperative characteristics, survival rates, and PSM-related complications between MRSA and MSSA groups.
- Logistic regression analysis to determine independent risk factors for mortality.
Main Results:
- No significant difference in perioperative characteristics between MRSA and MSSA groups.
- Significantly lower actuarial survival rates in patients with MRSA PSM compared to MSSA PSM (P=.04).
- Higher rates of PSM-related death and treatment failure in the MRSA group (P=.03 and P=.02, respectively).
- MRSA identified as the sole independent risk factor for overall mortality.
Conclusions:
- The clinical outcome of PSM caused by MRSA is significantly poorer than that caused by MSSA.
- MRSA infection is associated with increased mortality and treatment failure in PSM.
- Early identification and targeted treatment of MRSA are critical for improving PSM patient survival.