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Intervention program reduced MRSA infections by 93% after cardiothoracic surgery
Walsh E. Arch Intern Med. 2011;171:68-73.
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An intervention program resulted in sustained elimination of methicillin-resistant Staphylococcus aureus wound infections after cardiothoracic surgery. Postoperative methicillin-resistant Staphylococcus aureus-related infections decreased by 93%, according to new findings published in Archives of Internal Medicine.
“Cardiothoracic surgical programs with high MRSA infection rates may benefit by adopting our program,” Edward E. Walsh, MD, of Rochester General Hospital, told Infectious Disease News. “The net benefits of our program have been enormous, both in medical care costs to our institution, the insurers, and to patients suffering.”
Previous research suggests surgical site infections (SSIs) after cardiothoracic surgery caused by MRSA have increased steadily in recent years. In the current study, Walsh and colleagues reported that MRSA infections accounted for 54% of all SSIs at Rochester General Hospital between 2004 and 2007.
As a result, the researchers instituted an intervention program in which patients were screened for MRSA colonization, were assigned intranasal mupirocin regardless of colonization status, and patients previously colonized with MRSA were assigned vancomycin. Rates for postoperative wound infections were compared for the 3 years before and after initiation of the intervention program.
An immediate and significant decrease in MRSA-related SSI incidence after initiation of the intervention was observed, according to the researchers. Compared with 32 infections per 2,767 cases during the baseline period, there were only two infections per 2,496 cases during the intervention period (RR=0.069; P<.001) — indicating a 93% decrease in postoperative MRSA-related infections.
Moreover, there was an overall decrease in wound infection rates from 2.1% to 0.8% (59 infections per 2,769 cases vs. 20 infections per 2,496 cases; P<.001).
“It is possible to design comprehensive programs that are highly effective at eradicating surgical wound infections due to MRSA, and the unique aspect of our approach was to assume that the majority of MRSA infections occur in patients who are not colonized with MRSA on admission,” Walsh said. “This is important since most other programs to deal with MRSA only target those persons who enter the hospital with MRSA colonization, whereas we target all patients as we assume that many MRSA-negative patients will become colonized shortly after surgery thus leading to infection.” - by Ashley DeNyse
Disclosures: Dr. Walsh has no direct financial interest to report.
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