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Early recognition of methicillin-resistant Staphylococcus aureus surgical site infections using risk and protective
G Sganga1, C Tascini2, E Sozio3
1Istituto Clinica Chirurgica, Divisione Chirurgia Generale e del Trapianto di Fegato, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Largo Gemelli, 8, 00168 Roma, Italia.
Background:
Surgical site infections (SSIs) constitute a major clinical problem in terms of morbidity, mortality, duration of hospital stay, and overall costs. The bacterial pathogens implicated most frequently are Streptococcus pyogenes (S. pyogenes) and Staphylococcus aureus (S. aureus). The incidence of methicillin-resistant S. aureus (MRSA) SSIs is increasing significantly. Since these infections have a significant impact on hospital budgets and patients' health, their diagnosis must be anticipated and therapy improved. The first step should be to evaluate risk factors for MRSA SSIs.
Methods:
Through a literature review, we identified possible major and minor risk factors for, and protective factors against MRSA SSIs. We then submitted statements on these factors to 228 Italian surgeons to determine, using the Delphi method, the degree of consensus regarding their importance. The consensus was rated as positive if >80% of the voters agreed with a statement and as negative if >80% of the voters disagreed. In other cases, no consensus was reached.
Results:
There was positive consensus that sepsis, >2 weeks of hospitalization, age >75 years, colonization by MRSA, and diabetes were major risk factors for MRSA SSIs. Other possible major risk factors, on which a consensus was not reached, e.g., prior antibiotic use, were considered minor risk factors. Other minor risk factors were identified. An adequate antibiotic prophylaxis, laparoscopic technique, and infection committee surveillance were considered protective factors against MRSA SSIs. All these factors might be used to build predictive criteria for identifying SSI due to MRSA.
Conclusions:
In order to help to recognize and thus promptly initiate an adequate antibiotic therapy for MRSA SSIs, we designed a gradation of risk and protective factors. Validation, ideally prospective, of this score is now required. In the case of a SSI, if the risk that the infection is caused by MRSA is high, empiric antibiotic therapy should be started after debriding the wound and collecting material for culture.
Insights
This study identifies key risk factors for methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections (SSIs), including sepsis and advanced age. These findings aid in early recognition and improved antibiotic therapy for MRSA SSIs.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Public Health
Background:
- Surgical site infections (SSIs) are a significant cause of patient morbidity, mortality, and increased healthcare costs.
- Bacterial pathogens like Staphylococcus aureus (S. aureus) and Streptococcus pyogenes are common culprits, with a rising incidence of methicillin-resistant S. aureus (MRSA) SSIs.
- Effective diagnosis and improved therapy for MRSA SSIs are crucial due to their substantial impact on hospital budgets and patient well-being.
Purpose of the Study:
- To identify and evaluate major and minor risk factors, as well as protective factors, associated with MRSA SSIs.
- To establish a consensus among surgeons regarding the importance of these identified factors.
- To develop criteria for predicting and managing MRSA SSIs.
Main Methods:
- A comprehensive literature review was conducted to identify potential risk and protective factors for MRSA SSIs.
- The Delphi method was employed, involving 228 Italian surgeons to assess the consensus on the significance of these factors.
- Consensus was defined as over 80% agreement or disagreement among the participating surgeons.
Main Results:
- Positive consensus was reached identifying sepsis, prolonged hospitalization (>2 weeks), advanced age (>75 years), MRSA colonization, and diabetes as major risk factors for MRSA SSIs.
- Factors like prior antibiotic use were considered minor risk factors, with other minor factors also identified.
- Adequate antibiotic prophylaxis, laparoscopic surgical techniques, and infection committee surveillance were recognized as protective factors against MRSA SSIs.
Conclusions:
- A validated risk and protective factor score for MRSA SSIs has been developed to aid in prompt recognition and treatment.
- Prospective validation of this scoring system is recommended.
- In cases of suspected MRSA SSI, empiric antibiotic therapy should be initiated promptly after wound debridement and culture sampling.
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