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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Surgical site infection with methicillin-resistant Staphylococcus aureus after primary total hip replacement
R J Walls1, S J Roche, A O'Rourke
1Department of Orthopaedic and Trauma Surgery, Merlin Park University Hospital, Dublin Road, Galway, Ireland. raywalls1@hotmail.com
Abstract:
We have analysed the management and clinical outcome of a series of consecutive patients who had a total hip replacement and developed post-operative surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus. The incidence of this infection was 1% over a period of five years. We studied SSI in 15 patients (16 infections) with a mean age of 72.7 years (53 to 81). In all, 12 of the infections occurred early and half of the infections involved the prosthesis, resulting in an increase of 11-fold in the cumulative hospital stay. Methicillin-resistant Staph. aureus was successfully eradicated in all the patients after a mean follow-up of 53.6 months (25 to 88). Superficial incisional infections resolved after antibiotic therapy alone while deep infections required multiple operative debridements. Attempted retention of the implant in early organ space infections was successful in only one of five patients. Only three patients with implant-level infections obtained a pain-free, functional prosthesis while a further three required excision arthroplasty. We have formulated a protocol of treatment which may serve as a guide in the management of these infections.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) hip replacement infections are rare (1%) but serious. Effective management protocols led to successful MRSA eradication in all patients, though implant retention was challenging.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Post-operative surgical site infections (SSI) following total hip replacement (THR) can lead to significant morbidity.
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a growing challenge in healthcare-associated infections.
Purpose of the Study:
- To analyze the management and clinical outcomes of patients with MRSA SSI after THR.
- To evaluate the effectiveness of treatment protocols for MRSA THR infections.
Main Methods:
- Retrospective analysis of consecutive patients who developed MRSA SSI after THR.
- Review of infection characteristics, treatment strategies, and patient outcomes.
- Data collection on demographics, infection timing, prosthesis involvement, hospital stay, and follow-up.
Main Results:
- MRSA SSI incidence was 1% over five years, affecting 15 patients (16 infections) with a mean age of 72.7 years.
- Early infections (12) and prosthesis involvement (50%) significantly increased hospital stay (11-fold).
- All MRSA infections were eradicated after a mean follow-up of 53.6 months; superficial infections resolved with antibiotics, deep infections required debridement, and implant retention was successful in only 1 of 5 early organ space infections.
Conclusions:
- MRSA SSI after THR requires a structured management approach.
- While MRSA can be eradicated, preserving a functional prosthesis, especially in deep-seated infections, remains a significant challenge.
- A treatment protocol is proposed to guide the management of these complex infections.
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