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Predictors for surgical site infections due to MRSA found
Patients with MRSA surgical site infections were more likely to have Medicare and to be obese.
ORLANDO, Fla. — Functional status of patients obtained prior to surgery could be used to target methicillin-resistant Staphylococcus aureus prevention initiatives, according to study results presented at the 18th Annual Scientific Meeting of the Society for Healthcare and Epidemiology of America.
Researchers from Duke University Medical Center and the Durham Veterans Administration Medical Center identified four independent predictors for surgical site infection due to MRSA.
Patients who needed assistance with more than three activities of daily living, had Medicare insurance, were obese and had longer times in the operating room had increased risk for surgical site infection due to MRSA. Decreased functional status was the strongest predictor of surgical site infection.
“If you need any assistance with even one activity of daily living, you were at much higher risk for MRSA surgical site infection,” Deverick J. Anderson, MD, MPH, a physician in infectious diseases and international health at Duke University Medical Center, said at the meeting. “If you needed assistance with three or more activities, you were in a very high-risk group.”
Patient data reviewed
Patients with surgical site infections due to MRSA (n=150; mean age, 62.1 years) were matched with controls (n=231; mean age, 65.7 years) in a retrospective, case-control study conducted at seven hospitals (one tertiary care and six community hospitals).
Cases were identified as patients who had surgical site infections from MRSA from Jan. 1, 1998 to April 1, 2003.
Surgical site infection data were collected prospectively, and chart reviews yielded demographic and clinical patient data. Variables associated with surgical site infection caused by MRSA were determined by multivariable logistic regression and bivariate analysis.
“Surprisingly, with only 150 cases, this is the largest study to date presented on MRSA surgical site infections,” Anderson said.
MRSA risk factors determined
Patients with surgical site infections due to MRSA needed assistance with an average of 7.3 daily living activities. Patients were more than two times as likely to have Medicare insurance, were nearly four times as likely to require assistance with daily activities and were more likely to have prolonged surgical procedures. They were also more likely to be classified as obese than control patients.
In bivariate analysis, Medicare insurance, chronic obstructive pulmonary disease, a wound class of greater than two, liver disease and greater surgical procedure length of time all increased likelihood of surgical site infection caused by MRSA.
Poor functional status was associated with surgical site infection but not with increased age. “We are hypothesizing that this may be due to increased exposure to health care,” Anderson said.
The researchers found patients with surgical site infections caused by MRSA received appropriately chosen and timed antimicrobial prophylaxis. – by Kirsten H. Ellis
For more information:
- Anderson DJ, Chen LF, Sexton DJ, et al. Risk factors for surgical site infections due to methicillin-resistant Staphylococcus aureus: a multi-center case-control study. Presented at: the 18th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 5-8, 2008; Orlando, Fla.