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Updated: Apr 8, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Adverse Clinical Outcomes and Resource Utilization Associated with Methicillin-Resistant and Methicillin-Sensitive
Rebecca S Campbell1, Matthew F Emons1, Jack Mardekian2
11 Cerner Research , Culver City, California.
Background:
Current studies of post-operative Staphylococcus aureus disease focus primarily on surgical site infections and are often limited to infections caused by methicillin-resistant Staphylococcus aureus (MRSA). The objective of this retrospective cohort analysis was to describe the occurrence of and outcomes associated with post-operative MRSA and methicillin-sensitive S. aureus (MSSA) infections in patients undergoing elective surgical procedures.
Methods:
Data were extracted from Health Facts for inpatients aged 18 years or older with pre-defined International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, meeting additional criteria indicating that the procedure was elective. Post-operative S. aureus infection was identified by one or more qualifying culture positive for MRSA or MSSA. Multivariable regression models compared patients with MRSA, MSSA, and no S. aureus infection.
Results:
Among 34,866 qualifying patients, the incidence of S. aureus infections was 0.9% during the index admission and 1.7% within 90 d after elective surgery, of which 36.6% and 38.4% were MRSA, respectively. The highest rates were observed among patients undergoing general surgery (2.2% during index admission, 3.2% within 90 d) and plastic surgery (1.8% during index admission, 3.1% within 90 d). Patients with MRSA and MSSA experienced poorer outcomes than uninfected patients, based on index admission length of stay (LOS; mean, 30.2, 22.7, and 5.7 d, respectively), hospital charges ($165,651, $134,313, and $52,077), and hospital mortality (odds ratios, 6.4 for MRSA, 4.8 for MSSA versus uninfected patients). Relative to MSSA infection, MRSA infection was associated with greater total hospital LOS and hospital charges but not with increased re-admission or mortality.
Conclusions:
The burden of post-operative S. aureus infection is shared among elective surgical procedures, however, rates and types of infections vary. Whereas MRSA infection results in substantially greater health care cost and LOS, mortality and re-admission rates are similar among patients with MRSA and MSSA. In elective surgery, infection control and surveillance for both MRSA and MSSA are warranted.
Insights
Post-operative Staphylococcus aureus infections, including MRSA and MSSA, increase healthcare costs and length of stay. Surveillance and infection control for both MRSA and MSSA are crucial in elective surgery.
Area of Science:
- Infectious Diseases
- Surgical Outcomes
- Healthcare Epidemiology
Background:
- Post-operative Staphylococcus aureus infections are a significant concern, often focusing on MRSA surgical site infections.
- This study broadens the scope to include both MRSA and MSSA in elective surgical procedures.
Purpose of the Study:
- To describe the incidence and outcomes of post-operative methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) infections.
- To compare outcomes between MRSA, MSSA, and uninfected patients undergoing elective surgery.
Main Methods:
- Retrospective cohort analysis of inpatient data using ICD-9-CM codes for elective procedures.
- Identification of S. aureus infections through positive cultures for MRSA or MSSA.
- Multivariable regression models to compare outcomes among infected and uninfected patient groups.
Main Results:
- The incidence of S. aureus infections was 0.9% during index admission and 1.7% within 90 days post-elective surgery, with MRSA accounting for 36.6-38.4%.
- General and plastic surgery had the highest infection rates.
- MRSA and MSSA infections were associated with significantly longer length of stay, higher hospital charges, and increased mortality compared to uninfected patients.
Conclusions:
- Post-operative S. aureus infections, both MRSA and MSSA, represent a substantial burden in elective surgery, with varying rates across procedure types.
- While MRSA infections lead to greater healthcare costs and longer hospital stays, mortality and readmission rates are similar to MSSA infections.
- Effective infection control and surveillance strategies for both MRSA and MSSA are essential in elective surgical settings.
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