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The impact of methicillin-resistant Staphylococcus aureus in a neurosurgical unit: a growing problem
Kanna K Gnanalingham1, Ashraf Elsaghier, Christopher Kibbler
1Department of Neurosurgery and Microbiology, Royal Free Hospital, London, United Kingdom. kannagnana@hotmail.com
Object:
Methicillin-resistant Staphylococcus aureus (MRSA) infection is a growing problem worldwide. To investigate the severity of the problem, the authors surveyed the incidence of MRSA colonization and infection in the neurosurgical unit at their institution.
Methods:
Patients colonized or infected with MRSA who had been treated in the neurosurgical unit between 1993 and 1999 were retrospectively identified from laboratory records. There were 203 patients with MRSA-positive cultures, and the incidence of infection increased between 1993 (16 cases; 1.9% of admissions) and 1999 (60 cases; 6.7% of admissions). The mean duration of hospital stay was longer in patients with MRSA than in all patients treated in the unit (33.6 compared with 10.3 days, p < 0.001). Methicillin-resistant S. aureus was isolated from the nose in 89 patients, the throat in 79, the perineum in 52, surgical wounds in 16, sputum in 15, blood in 10, and from multiple sites in 69 patients. Fifty-six patients (28%) were infected with MRSA, and there were 15 deaths, of which three (20%) were likely to be due to the infection. The sources of MRSA included the neurosurgical ward in 84 patients, the intensive care unit in 28, other hospitals in 39, and the community in 17. The common strains of MRSA isolated were epidemic (E)MRSA- 16 (110 cases) and EMRSA-15 (31 cases). The microorganism was eradicated in 16 cases, not eradicated in 20, and 167 patients were discharged from the hospital before eradication was achieved. All MRSA isolates were sensitive to vancomycin and teicoplanin and there was reduced sensitivity to mupirocin.
Conclusions:
Infection with MRSA is a growing problem in the neurosurgical population, and most cases are hospital-acquired and are associated with longer hospital stays. Asymptomatic colonization by this organism is far more common than infection of the surgical wound, although there is still morbidity due to MRSA sepsis. Most patients with MRSA are discharged before eradication of infection is achieved, thus increasing the risk that the infection will spread in the community. Strict adherence to the basic principles of infection control is the key to eradication of MRSA.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing in neurosurgery patients, leading to longer hospital stays. Most MRSA cases are hospital-acquired, with asymptomatic colonization more common than infection, highlighting the need for strict infection control.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Hospital Epidemiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant global health threat.
- The incidence of MRSA colonization and infection in neurosurgical units requires thorough investigation.
Purpose of the Study:
- To determine the incidence and characteristics of MRSA colonization and infection within a neurosurgical unit.
- To assess the impact of MRSA on hospital stay duration and patient outcomes.
Main Methods:
- Retrospective analysis of 203 patients with MRSA-positive cultures treated in the neurosurgical unit from 1993 to 1999.
- Data collection included patient demographics, MRSA isolation sites, infection status, hospital acquisition sources, and treatment outcomes.
Main Results:
- MRSA incidence increased from 1.9% to 6.7% of admissions between 1993 and 1999.
- MRSA-infected patients had significantly longer hospital stays (33.6 vs. 10.3 days).
- Asymptomatic colonization (89 nasal, 79 throat) was more frequent than infection (56 cases), with hospital acquisition in 84 patients.
Conclusions:
- MRSA infection is a growing concern in neurosurgery, predominantly hospital-acquired, and linked to prolonged hospitalizations.
- Asymptomatic MRSA colonization is common, contributing to potential community spread upon patient discharge before eradication.
- Enhanced infection control measures are crucial for MRSA eradication in this patient population.