Abstract
We prospectively studied the incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonisation and infection, the patterns and types of operation associated with MRSA acquisition in an orthopaedic and trauma unit in London, UK. Over the 12-month study period from January to December 2000, we found that 1.6% of the total admission was diagnosed to be either MRSA infected or colonised, with an average of three new MRSA cases detected per month. A significant proportion of patients (23%) were diagnosed within the first 48h of admission. Both hip joint surgery, especially emergency procedures for femoral neck fractures, and the presence of a wound presented higher risk of infection. The Intensive Care Unit (ICU) did not appear to be a significant source for intra-hospital dissemination among the orthopaedic patients. MRSA infection or colonisation contributed to an increased length of hospital stay; 88 days compared to 11 days on average for non-MRSA patients; 41% of the positive patients still carried MRSA on discharge. Our data show the importance of diagnosing MRSA in orthopaedic surgery and emphasises that understanding its epidemiology will be crucial to secure a decrease in the incidence of MRSA. Hand hygiene, patient screening, careful surveillance of infections and the prompt implementation of isolation policies, are essential components of control.
Résumé
Nous avons étudié de façon prospective la fréquence de colonisation et d'infection par le SAMR, les modèles et types d'opération associés avec l'acquisition de SAMR dans une unité d'orthopédie et traumatologie à Londres. Sur la période de l'étude, douze mois de janvier à décembre 2000, nous avons trouvé que 1,6% des admissions portaient le diagnostic de colonisation ou d'infection à SAMR, avec une moyenne de trois nouveaux cas détectés par mois. Une proportion importante de malades (23%) a été diagnostiqué dans les 48 premières heures d'admission. La chirurgie de la hanche, surtout les traitements en urgence pour fracture du col fémoral, et la présence d'une blessure avaient des risques supérieurs d'infection. L'Unité de soins intensifs n'est pas apparue comme une source significative de dissémination intra-hospitalière parmi les malades orthopédiques. L'infection ou la colonisations à SAMR ont contribué à un allongement du séjour à l'hôpital : 88 jours, comparés à 11 jours en moyenne pour les malades sans SAMR. Nos données montrent l'importance de diagnostiquer la présence de SAMR en chirurgie orthopédique et de comprendre son épidémiologie pour assurer une décroissance de l'incidence des infections à ce type de germe. L'hygiène des mains, l'étude des patients, la surveillance soigneuse des infections et la mise en oeuvre rapide de politiques d'isolement, sont des composantes essentielles du contrôle.
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Tai, C.C., Nirvani, A.A., Holmes, A. et al. Methicillin-resistant Staphylococcus aureus in orthopaedic surgery. International Orthopaedics (SICOT) 28, 32–35 (2004). https://doi.org/10.1007/s00264-003-0505-2
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DOI: https://doi.org/10.1007/s00264-003-0505-2