Methicillin-resistant Staphylococcus aureus in hip fracture
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Updated: Jun 20, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Simon Craxford1, Ben Arthur Marson1, Eshan Oderuth2
1The University of Nottingham, Nottingham, UK.
Aims:
Infection after surgery increases treatment costs and is associated with increased mortality. Hip fracture patients have historically had high rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization and surgical site infection (SSI). This paper reports the impact of routine MRSA screening and the "cleanyourhands" campaign on rates of MRSA SSI and patient outcome.
Methods:
A total of 13,503 patients who presented with a hip fracture over 17 years formed the study population. Multivariable logistic regression was performed to determine risk factors for MRSA and SSI. Autoregressive integrated moving average (ARIMA) modelling adjusted for temporal trends in rates of MRSA. Kaplan-Meier estimators were generated to assess for changes in mortality.
Results:
In all, 6,189 patients were identified before the introduction of screening and 7,314 in the post-screening cohort. MRSA infection fell from 69 cases to 15 in the post-screening cohort (p < 0.001). The ARIMA confirmed a significant reduction in MRSA SSI post-screening (p = 0.043) but no significant impact after hand hygiene alone (p = 0.121). Overall SSI fell (2.4% to 1.5%), however deep infection increased slightly (0.89% to 1.06%). ARIMA showed neither intervention affected overall SSI ("cleanyourhands" -0.172% (95% confidence interval (CI) -0.39% to 0.21); p = 0.122, screening -0.113% per year, (95% CI -0.34 to 0.12); p = 0.373). One-year mortality after deep SSI was unchanged after screening (50% vs 45%; p = 0.415). Only warfarinization (OR 3.616 (95% CI 1.366 to 9.569); p = 0.010) and screening (OR 0.189 (95% CI 0.086 to 0.414); p < 0.001) were significant covariables for developing MRSA SSI.
Conclusion:
While screening and decolonization may reduce MRSA-associated SSI, the benefit to patient outcome remains unclear. Overall deep SSI remains an unsolved problem that has seen little improvement over time. Preventing other hospital-associated infections should not be forgotten in the fight against MRSA. Cite this article: Bone Joint J 2021;103-B(1):170-177.
Insights
Routine methicillin-resistant Staphylococcus aureus (MRSA) screening significantly reduced MRSA surgical site infections (SSIs) in hip fracture patients. However, the impact on overall patient outcomes and deep SSIs remains unclear, highlighting the need for continued infection control efforts.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Public Health Interventions
Background:
- Hip fracture patients face high risks of methicillin-resistant Staphylococcus aureus (MRSA) colonization and surgical site infections (SSIs).
- Surgical site infections increase treatment costs and mortality rates.
Purpose of the Study:
- To evaluate the impact of routine MRSA screening and the "cleanyourhands" campaign on MRSA SSI rates.
- To assess the effect of these interventions on patient outcomes, including mortality and overall SSI rates.
Main Methods:
- Analysis of 13,503 hip fracture patients over 17 years, comparing pre- and post-screening cohorts.
- Multivariable logistic regression and Autoregressive Integrated Moving Average (ARIMA) modeling to identify risk factors and temporal trends.
- Kaplan-Meier estimators used to assess changes in mortality.
Main Results:
- MRSA SSIs decreased significantly from 69 to 15 cases post-screening (p < 0.001).
- Routine screening reduced MRSA SSIs, while the "cleanyourhands" campaign showed no significant impact on MRSA SSIs (p = 0.121).
- Overall SSI rates decreased, but deep SSI rates slightly increased; neither intervention significantly impacted overall SSI rates.
Conclusions:
- Routine MRSA screening may reduce MRSA-associated SSIs, but its benefit on overall patient outcomes requires further investigation.
- Deep surgical site infections remain a persistent challenge in hip fracture care.
- Continued focus on preventing all hospital-associated infections is crucial alongside MRSA-specific strategies.
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