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Sustained reduction in methicillin-resistant Staphylococcus aureus wound infections after cardiothoracic surgery

Edward E Walsh1, Linda Greene, Ronald Kirshner

  • 1Division of Infectious Diseases, University of Rochester School of Medicine and Dentistry and Rochester General Hospital, Rochester, NY 14621, USA. Edward.walsh@rochestergeneral.org

Archives of Internal Medicine
|September 15, 2010
PubMed
Abstract

Insights

A comprehensive intervention program significantly reduced Methicillin-resistant Staphylococcus aureus (MRSA) wound infections after cardiac surgery by 93%. The program involved screening, vancomycin for carriers, and intranasal mupirocin for all patients.

Area of Science:

  • Infectious Diseases
  • Surgical Site Infections
  • Antimicrobial Resistance

Background:

  • Rising rates of Methicillin-resistant Staphylococcus aureus (MRSA) wound infections post-cardiac surgery pose significant clinical challenges.
  • MRSA accounted for 56% of postoperative infections in the study hospital, highlighting the need for effective control measures.

Purpose of the Study:

  • To evaluate the effectiveness of a comprehensive intervention program in reducing MRSA wound infections following cardiac surgery.
  • To assess the impact of the intervention on overall postoperative wound infection rates.

Main Methods:

  • A comparative study design was employed, comparing infection rates in the 3 years before and after the intervention.
  • The intervention included: preoperative MRSA screening, vancomycin prophylaxis for carriers, and universal 5-day intranasal mupirocin application pre-surgery.
  • Mupirocin was also applied to chest tube sites upon removal.

Main Results:

  • Postoperative MRSA wound infections decreased by 93% (32 to 2 cases), with a relative risk of 0.069 (P < .001).
  • Overall wound infection rates dropped from 2.1% to 0.8% (P < .001).
  • No significant change in MRSA infections after non-cardiac surgery was observed during the intervention period.

Conclusions:

  • A comprehensive MRSA intervention program, combining universal intranasal mupirocin with targeted vancomycin prophylaxis, achieved near-complete elimination of MRSA wound infections post-cardiac surgery.
  • The observed reduction in MRSA infections was sustained, demonstrating the program's long-term efficacy.

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