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Published on: June 4, 2012
Methicillin-resistant Staphylococcus aureus preventing strategy in cardiac surgery
Aikaterini Mastoraki1, Ioannis Kriaras, Evangelia Douka
1Department of Surgical Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Sygrou Ave, 17674 Athens, Greece. drkamast@yahoo.gr
Objectives:
The aim of this survey was to elucidate the efficacy of methicillin-resistant Staphylococcus aureus (MRSA) preventing strategy in our institution by investigating the incidence and evaluating the morbidity and mortality associated with this multi-resistant virulent organism.
Methods:
A prospective observational cohort among patients submitted to cardiovascular surgical procedures was conducted from 1 January 1997 to 31 December 2005. Preventing strategy included active screening programs by nasal swabs for all patients admitted from other hospitals or being at risk for developing infectious complications. Carriers or infected patients remained isolated and were treated promptly. Furthermore, all newly employed health care workers were screened for MRSA and carriers were treated with mupirocin until the eradication of the pathogen.
Results:
Throughout the 9-year study period 826 infectious complications were registered among 15,270 cardiac surgical patients. Total infection rate was 5.4%. MRSA was identified in 86 patients; 56 patients proved carriers and 30 infected. The MRSA associated infection rate was 0.2%. During this period of time mean ICU stay was 1.7 days and ICU mortality rate was 2.9%. MRSA infected patients presented a mean ICU stay of 46.5 days and a mortality rate of 30%. In ten patients, MRSA was detected in tracheal secretions, in four patients in swabs taken from donor site infection and in four patients from superficial sternal surgical wound. In ten patients the pathogen was isolated from cultures of the surgical site drainage and the diagnosis of post-sternotomy mediastinitis was confirmed. The remaining two patients were defined as having severe sepsis; MRSA was documented in central venous catheter tips and blood cultures.
Conclusions:
The prompt determination, isolation and appropriate treatment of MRSA patients admitted from other institutions combined with the detection and elimination of carriers among new health care workers and patients at high risk of developing infectious complications prevented further spread of the pathogen.
Insights
Implementing a comprehensive methicillin-resistant Staphylococcus aureus (MRSA) prevention strategy, including screening and prompt treatment, significantly reduced MRSA spread in cardiovascular surgical patients. This approach lowered infection rates and associated mortality.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Surgical Site Infections
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings, particularly in vulnerable patient populations like those undergoing cardiovascular surgery.
- Effective prevention strategies are crucial to mitigate the morbidity and mortality associated with MRSA infections.
Purpose of the Study:
- To evaluate the effectiveness of an institutional MRSA prevention strategy.
- To determine the incidence, morbidity, and mortality associated with MRSA in cardiovascular surgical patients.
Main Methods:
- A prospective observational cohort study of 15,270 cardiovascular surgical patients from 1997 to 2005.
- Implementation of active screening for MRSA carriers via nasal swabs in high-risk patients and newly employed healthcare workers.
- Isolation and prompt treatment of MRSA carriers and infected patients.
Main Results:
- The overall infection rate was 5.4%, with an MRSA-associated infection rate of 0.2% (86 MRSA cases out of 15,270 patients).
- MRSA-infected patients experienced a significantly longer ICU stay (46.5 days vs. 1.7 days) and a higher mortality rate (30% vs. 2.9%) compared to non-MRSA infected patients.
- MRSA was identified in various sites, including tracheal secretions, surgical wounds, drainage fluid, and blood cultures, leading to complications like post-sternotomy mediastinitis and severe sepsis.
Conclusions:
- A multi-faceted MRSA prevention strategy, encompassing early detection, isolation, and treatment of infected patients and carriers, effectively curbed pathogen spread.
- The findings underscore the importance of rigorous screening and management protocols for MRSA in high-risk surgical populations.
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