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Implications of Methicillin-Resistant Staphylococcus aureus Carriage on Cardiac Surgical Outcomes

Krish C Dewan1, Karan S Dewan1, Suparna M Navale2

  • 1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.

The Annals of Thoracic Surgery
|May 11, 2020
PubMed
Abstract

Insights

Preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization did not increase mortality or surgical site infections (SSIs) in cardiac surgery patients. However, MRSA carriers had higher rates of postoperative MRSA infection and septicemia.

Area of Science:

  • Infectious Diseases
  • Cardiovascular Surgery
  • Public Health

Background:

  • Staphylococcus aureus is a leading cause of sternal surgical site infections (SSIs).
  • Preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization's impact on postoperative outcomes remains debated.
  • This study investigates the effect of MRSA carriage on cardiac surgery outcomes.

Purpose of the Study:

  • To determine if MRSA colonization influences postoperative outcomes and safety in cardiac surgical patients.
  • To compare outcomes between MRSA carriers and non-carriers undergoing cardiac surgery.

Main Methods:

  • Analysis of 1,774,811 cardiac surgical patients from the National Inpatient Sample (2009-2014).
  • Identification of 5,798 (0.33%) MRSA carriers within the cohort.
  • Application of propensity-score matching to control for confounding variables and compare outcomes.

Main Results:

  • MRSA carriers underwent more urgent surgeries but showed no significant differences in mortality, stroke, SSIs, or major complications compared to non-carriers.
  • MRSA carriers experienced higher rates of postoperative MRSA infection (P < .001) and septicemia (P = 0.03).
  • Hospital length of stay was longer for MRSA carriers (P = .005), with no significant cost increase (P = .12).

Conclusions:

  • MRSA carriers undergoing cardiac surgery face similar mortality and SSI risks as non-carriers.
  • Despite low rates, increased postoperative MRSA infection and septicemia in carriers highlight the need for targeted screening and prophylaxis.
  • Selective preoperative screening and prophylactic measures may be beneficial for MRSA carriers undergoing cardiac procedures.

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