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Impact of Methicillin-resistant Staphylococcus aureus Infection on Outcome after Esophagectomy

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Abstract

Background

Infection with methicillin-resistant Staphylococcus aureus (MRSA) has reached endemic proportions in the United Kingdom. The aim of the present study was to determine the frequency of MRSA infection in patients undergoing esophagectomy and to report its impact on patient outcome.

Patients and Methods

The study population was 98 patients undergoing esophagectomy for carcinoma during the years 1998–2004. Patient information was collected prospectively and entered into a computerized database and analyzed retrospectively by univariate and multivariate analysis.

Results

Overall, 20 of the 98 patients (20%) developed infection with MRSA after esophagectomy. Patients who developed MRSA infection had greater levels of postoperative morbidity, longer intensive care unit (ICU) stays (median 2 days versus 1 day, P = 0.005) and hospital stays (21 days versus 16 days, P < 0.001) compared to those who did not develop infection. Multivariate analysis identified preoperative chemotherapy (P = 0.006) and readmission to the ICU (P = 0.007) as significant risk factors with MRSA infection. Overall, 17 of 46 patients (37%) who received neoadjuvant chemotherapy developed MRSA infection, compared to 3 of 52 (6%) who did not receive this treatment (P = 0.0001).

Conclusions

Overall, one in five patients undergoing esophagectomy developed MRSA infection, with those patients who received neoadjuvant chemotherapy identified as being at greatest risk of this complication. This is an alarming finding, as neoadjuvant chemotherapy is the standard of care for patients with esophageal carcinoma in the United Kingdom.

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References

  1. Department of Health Bacteraemia Surveillance Scheme. HMSO 2005

  2. Health Protection Agency. Staphylococcus aureus bacteraemia laboratory reports and methicillin susceptibility (voluntary reporting scheme): England and Wales, 1990–2003. HMSO 2005

  3. Mandatory Staphylococcus aureus bacteraemia surveillance in acute NHS trusts in Wales April 2001–March 2003. NPHS Communicable Disease Surveillance Centre 2003

  4. Dimick JB, Provonost PJ, Cowan JA Jr, et al. Variation in postoperative complication rates after high-risk surgery in the United States. Surgery 2003;134:534–540

    Article  PubMed  Google Scholar 

  5. Walsh TN, Noonan N, Hollywood D, et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 1996;335:462–467

    Article  PubMed  CAS  Google Scholar 

  6. Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 2002;359:1727–1733

    Article  Google Scholar 

  7. Fishbain JT, Lee JC, Nguyen HD, et al. Nosocomial transmission of methicillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates. Infect Control Hosp Epidemiol 2003;24:415–421

    Article  PubMed  Google Scholar 

  8. Scriven JM, Silva P, Swann RA, et al. The acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in vascular patients. Eur J Vasc Endovasc Surg 2003;25:147–151

    Article  PubMed  CAS  Google Scholar 

  9. Samad A, Banerjee D, Carbarns N, et al. Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients, on admission to a Welsh hospital. J Hosp Infect 2002;51:43–46

    Article  PubMed  CAS  Google Scholar 

  10. Lucet JC, Chevret S, Durand-Zaleski I, et al. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163:181–188

    Article  PubMed  Google Scholar 

  11. Corea E, de Silva T, Perera J. Methicillin-resistant Staphylococcus aureus: prevalence, incidence and risk factors associated with colonization in Sri Lanka. J Hosp Infect 2003;55:145–148

    Article  PubMed  CAS  Google Scholar 

  12. Fukuda M, Tanaka H, Kajiwara Y, et al. High-risk populations for nasal carriage of methicillin-resistant Staphylococcus aureus. J Infect Chemother 2004;10:189–191

    Article  PubMed  Google Scholar 

  13. Fraise AP, Mitchell K, O’Brien SJ, et al. Methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes in a major UK city: an anonymized point prevalence survey. Epidemiol Infect 1997;118:1–5

    Article  PubMed  CAS  Google Scholar 

  14. Desai D, Desai N, Nightingale P, et al. Carriage of methicillin-resistant Staphylococcus aureus is associated with an increased risk of infection after liver transplantation. Liver Transplantation 2003;9:754–759

    Article  PubMed  Google Scholar 

  15. Richards T, Pittathankel AA, Pursell R, et al. MRSA in lower limb amputation and the role of antibiotic prophylaxis. J Cardiovasc Surg 2005;46:37–41

    CAS  Google Scholar 

  16. Ridgeway S, Wilson J, Charlet A, et al. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg (UK) 2005;87:844–850

    Article  CAS  Google Scholar 

  17. Bagger JP, Zindrou D, Taylor KM. Postoperative infection with methicillin-resistant Staphylococcus aureus and socioeconomic background. Lancet 2004;363:706–708

    Article  PubMed  Google Scholar 

  18. Murphy GJ, Pararajasingam R, Nasim A, et al. Methicillin-resistant Staphylococcus aureus infection in vascular surgical patients. Ann R Coll Surg Engl 2001;83:158–163

    PubMed  CAS  Google Scholar 

  19. Watters K, O’Dwyer TP, Rowley H. Cost and morbidity of MRSA in head and neck cancer patients: what are the consequences? J Laryngol Otol 2004;118:694–699

    Article  PubMed  CAS  Google Scholar 

  20. Cosgrove SE, Qi Y, Kaye KS, et al. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174

    Article  PubMed  Google Scholar 

  21. Engemann JJ, Carmeli Y, Cosgrove SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598

    Article  PubMed  Google Scholar 

  22. Singh N, Squier C, Wannstedt C, et al. Impact of an aggressive infection control strategy on endemic Staphylococcus aureus infection in liver transplant recipients. Infect Control Hosp Epidemiol 2006;27:122–126

    Article  PubMed  Google Scholar 

  23. Nicholson MR, Huesman LA. Controlling the usage of intranasal mupirocin does impact the rate of Staphylococcus aureus deep sternal wound infections in cardiac surgery patients. Am J Infect Control 2006;34:44–48

    Article  PubMed  Google Scholar 

  24. Horiuchi A, Nakayama Y, Kajiyama M, et al. Nasopharyngeal decolonization of methicillin-resistant Staphlococcus aureus can reduce PEG peristomal wound infection. Am J Gastroenterol 2006;101:274–277

    Article  PubMed  Google Scholar 

  25. Perl TM, Cullen JJ, Wenzel RP, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002;346:1871–1877

    Article  PubMed  CAS  Google Scholar 

  26. Yano M, Doki Y, Inoue M, et al. Preoperative intranasal mupirocin ointment significantly reduces postoperative infection with Staphylococcus aureus in patients undergoing upper gastrointestinal surgery. Surg Today 2000;30:16–21

    Article  PubMed  CAS  Google Scholar 

  27. Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 1998;339:1979–1984

    Article  PubMed  CAS  Google Scholar 

  28. Vriens M, Blok H, Fluit A, et al. Costs associated with a strict policy to eradicate methicillin-resistant Staphylococcus aureus in a Dutch University Medical Center: a 10-year survey. Eur J Clin Microbiol Infect Dis 2002;21:782–786

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4X, United Kingdom

    David J. Bowrey MD, Martyn D. Evans MBBS & Geoffrey W. B. Clark MD

  2. Department of Surgery, Level 6 Balmoral Building, Leicester Royal Infirmary, Infirmary Square Leicester, LE1 5WW, United Kingdom

    David J. Bowrey MD

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  1. David J. Bowrey MD
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  2. Martyn D. Evans MBBS
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  3. Geoffrey W. B. Clark MD
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Correspondence to David J. Bowrey MD.

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Bowrey, D.J., Evans, M.D. & Clark, G.W.B. Impact of Methicillin-resistant Staphylococcus aureus Infection on Outcome after Esophagectomy. World J. Surg. 31, 326–331 (2007). https://doi.org/10.1007/s00268-006-0077-6

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  • DOI: https://doi.org/10.1007/s00268-006-0077-6

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