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Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery

Received: 8 June 2017     Accepted: 11 July 2017     Published: 16 August 2017
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Abstract

The problem of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and decolonisation strategies. Cardiac surgery unit admissions receive MRSA cultures from nares, skin, throat and wounds/groin, and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed. The study comprises 50 patients: 32 successfully decolonized/eradicated carriers and 18 unsuccessfully eradicated carriers. A comparison of pre-operative characteristics showed no statistically significant differences between the 2 groups with the exception for asthmatic patients, where there was only 3.1% of MRSA eradicated patients vs 22.2% in the unsuccessful eradication group (p=0.031). There was no difference between the operative patient data of both groups in hospital mortality, post-operative lengths of stay, ventilation time, post op IABP (intra-aortic balloon pump), post-operative complications, Cerebrovascular accidents and Transient Ischaemic attacks as well as long term complications were not statistically significant. However, there is a statistically significant difference between the use of post-operative antibiotics, with 72.2% of unsuccessfully MRSA eradicated patients requiring antibiotics postoperatively, compared to 40.6%, (p=0.032). Preoperative asthmatics were more likely to fail MRSA eradication/decolonisation. Post operatively MRSA eradication results in the reduction in postoperative antibiotic use.

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 3, Issue 3)
DOI 10.11648/j.ijcts.20170303.12
Page(s) 18-22
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

MRSA Eradication, Cardiothoracic Surgery, Surgical Site Infection

References
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[2] Barber M. Methicillin-Resistant Staphylococci and Hospital Infection. Postgrad Med J. 1964; 40: SUPPL: 178-81.
[3] Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh HA, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005; 5(12): 751-62.
[4] Eurosurveillance editorial t. ECDC publishes 2014 surveillance data on antimicrobial resistance and antimicrobial consumption in Europe. Euro Surveill. 2015; 20(46).
[5] Struelens MJ, Monnet D. Prevention of methicillin-resistant Staphylococcus aureus infection: is Europe winning the fight? Infect Control Hosp Epidemiol. 2010; 31 Suppl 1:S42-4.
[6] Dumitrescu O, Lina G. What is the place of linezolid in the treatment of methicillin-resistant Staphylococcus aureus nosocomial pneumonia and complicated skin and soft tissue infections in Europe? Clin Microbiol Infect. 2014; 20 Suppl 4: 1-2.
[7] Cimochowski GE, Harostock MD, Brown R, Bernardi M, Alonzo N, Coyle K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg. 2001; 71(5): 1572-8; discussion 8-9.
[8] Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, et al. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect. 2006; 63 Suppl 1:S1-44.
[9] Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE, et al. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother. 2006; 57(4): 589-608.
[10] Reddy SL, Grayson AD, Smith G, Warwick R, Chalmers JA. Methicillin resistant Staphylococcus aureus infections following cardiac surgery: incidence, impact and identifying adverse outcome traits. Eur J Cardiothorac Surg. 2007; 32(1): 113-7.
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[12] Zangrillo A, Landoni G, Fumagalli L, Bove T, Bellotti F, Sottocorna O, et al. Methicillin-resistant Staphylococcus species in a cardiac surgical intensive care unit: a 5-year experience. J Cardiothorac Vasc Anesth. 2006; 20(1): 31-7.
[13] Kalra L, Camacho F, Whitener CJ, Du P, Miller M, Zalonis C, et al. Risk of methicillin-resistant Staphylococcus aureus surgical site infection in patients with nasal MRSA colonization. Am J Infect Control. 2013; 41(12): 1253-7.
[14] Cho OH, Baek EH, Bak MH, Suh YS, Park KH, Kim S, et al. The effect of targeted decolonization on methicillin-resistant Staphylococcus aureus colonization or infection in a surgical intensive care unit. Am J Infect Control. 2016; 44(5): 533-8.
[15] Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002; 346(24): 1871-7.
[16] Kalmeijer MD, Coertjens H, van Nieuwland-Bollen PM, Bogaers-Hofman D, de Baere GA, Stuurman A, et al. Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis. 2002; 35(4): 353-8.
[17] Suzuki Y, Kamigaki T, Fujino Y, Tominaga M, Ku Y, Kuroda Y. Randomized clinical trial of preoperative intranasal mupirocin to reduce surgical-site infection after digestive surgery. Br J Surg. 2003; 90(9): 1072-5.
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Cite This Article
  • APA Style

    Sanjeet Avtaar Singh, Kasra Shaikhrezai, Rajdev Singh Toor, Ahmed Al-Adhami, Sudeep Das De, et al. (2017). Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery. International Journal of Cardiovascular and Thoracic Surgery, 3(3), 18-22. https://doi.org/10.11648/j.ijcts.20170303.12

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    ACS Style

    Sanjeet Avtaar Singh; Kasra Shaikhrezai; Rajdev Singh Toor; Ahmed Al-Adhami; Sudeep Das De, et al. Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery. Int. J. Cardiovasc. Thorac. Surg. 2017, 3(3), 18-22. doi: 10.11648/j.ijcts.20170303.12

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    AMA Style

    Sanjeet Avtaar Singh, Kasra Shaikhrezai, Rajdev Singh Toor, Ahmed Al-Adhami, Sudeep Das De, et al. Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery. Int J Cardiovasc Thorac Surg. 2017;3(3):18-22. doi: 10.11648/j.ijcts.20170303.12

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  • @article{10.11648/j.ijcts.20170303.12,
      author = {Sanjeet Avtaar Singh and Kasra Shaikhrezai and Rajdev Singh Toor and Ahmed Al-Adhami and Sudeep Das De and Renzo Pessotto},
      title = {Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery},
      journal = {International Journal of Cardiovascular and Thoracic Surgery},
      volume = {3},
      number = {3},
      pages = {18-22},
      doi = {10.11648/j.ijcts.20170303.12},
      url = {https://doi.org/10.11648/j.ijcts.20170303.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20170303.12},
      abstract = {The problem of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and decolonisation strategies. Cardiac surgery unit admissions receive MRSA cultures from nares, skin, throat and wounds/groin, and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed. The study comprises 50 patients: 32 successfully decolonized/eradicated carriers and 18 unsuccessfully eradicated carriers. A comparison of pre-operative characteristics showed no statistically significant differences between the 2 groups with the exception for asthmatic patients, where there was only 3.1% of MRSA eradicated patients vs 22.2% in the unsuccessful eradication group (p=0.031). There was no difference between the operative patient data of both groups in hospital mortality, post-operative lengths of stay, ventilation time, post op IABP (intra-aortic balloon pump), post-operative complications, Cerebrovascular accidents and Transient Ischaemic attacks as well as long term complications were not statistically significant. However, there is a statistically significant difference between the use of post-operative antibiotics, with 72.2% of unsuccessfully MRSA eradicated patients requiring antibiotics postoperatively, compared to 40.6%, (p=0.032). Preoperative asthmatics were more likely to fail MRSA eradication/decolonisation. Post operatively MRSA eradication results in the reduction in postoperative antibiotic use.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery
    AU  - Sanjeet Avtaar Singh
    AU  - Kasra Shaikhrezai
    AU  - Rajdev Singh Toor
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    T2  - International Journal of Cardiovascular and Thoracic Surgery
    JF  - International Journal of Cardiovascular and Thoracic Surgery
    JO  - International Journal of Cardiovascular and Thoracic Surgery
    SP  - 18
    EP  - 22
    PB  - Science Publishing Group
    SN  - 2575-4882
    UR  - https://doi.org/10.11648/j.ijcts.20170303.12
    AB  - The problem of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and decolonisation strategies. Cardiac surgery unit admissions receive MRSA cultures from nares, skin, throat and wounds/groin, and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed. The study comprises 50 patients: 32 successfully decolonized/eradicated carriers and 18 unsuccessfully eradicated carriers. A comparison of pre-operative characteristics showed no statistically significant differences between the 2 groups with the exception for asthmatic patients, where there was only 3.1% of MRSA eradicated patients vs 22.2% in the unsuccessful eradication group (p=0.031). There was no difference between the operative patient data of both groups in hospital mortality, post-operative lengths of stay, ventilation time, post op IABP (intra-aortic balloon pump), post-operative complications, Cerebrovascular accidents and Transient Ischaemic attacks as well as long term complications were not statistically significant. However, there is a statistically significant difference between the use of post-operative antibiotics, with 72.2% of unsuccessfully MRSA eradicated patients requiring antibiotics postoperatively, compared to 40.6%, (p=0.032). Preoperative asthmatics were more likely to fail MRSA eradication/decolonisation. Post operatively MRSA eradication results in the reduction in postoperative antibiotic use.
    VL  - 3
    IS  - 3
    ER  - 

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Author Information
  • Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK

  • Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK

  • Department of Anesthesiology, Fiona Stanley Hospital, Murdoch, Australia

  • Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK

  • Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK

  • Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK

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