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Risk factors for postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus.
E S Dodds Ashley1, D N Carroll, J J Engemann
1Duke University Medical Center, Durham, North Carolina 27710, USA. dodds002@mc.duke.edu
Summary
Diabetes, female sex, and older age increase the risk of developing methicillin-resistant Staphylococcus aureus (MRSA) postoperative mediastinitis (POM). Obesity is a risk factor for methicillin-susceptible S. aureus (MSSA) POM.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Staphylococcus aureus
Background:
- Postoperative mediastinitis (POM) is a serious complication following median sternotomy.
- Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) are common pathogens causing POM.
- Identifying specific risk factors for MRSA-related POM is crucial for targeted prevention strategies.
Purpose of the Study:
- To analyze risk factors associated with developing postoperative mediastinitis (POM) caused by methicillin-resistant Staphylococcus aureus (MRSA).
- To compare risk factors for MRSA-POM with those for POM caused by methicillin-susceptible S. aureus (MSSA).
Main Methods:
- A case-case control study design was employed.
- Three patient groups were analyzed: MRSA-POM (n=64), MSSA-POM (n=79), and uninfected controls (n=80).
- Multivariable analysis was used to identify independent risk factors.
Main Results:
- Diabetes (adjusted OR, 2.86), female sex (OR, 2.70), and age >70 years (OR, 3.43) were independently associated with increased risk of MRSA-POM.
- Obesity (OR, 2.49) was the only independent risk factor identified for MSSA-POM.
- The majority of patients (97%) received cephalosporin antibiotics for antimicrobial prophylaxis.
Conclusions:
- Specific patient demographics, including diabetes, female sex, and advanced age, are significant risk factors for MRSA-POM.
- Obesity is a key risk factor for MSSA-POM.
- Consideration of modified perioperative antimicrobial prophylaxis and other interventions is recommended for preventing MRSA-POM in high-risk patient populations.