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The Impact of MRSA Colonization on Surgical Site Infection Following Major Gastrointestinal Surgery

  • 2012 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

The purpose of this study is to determine whether methicillin-resistant Staphylococcus aureus (MRSA) colonization affects surgical site infections (SSI) after major gastrointestinal (GI) operations.

Methods

We retrospectively reviewed the charts of all patients undergoing major GI surgery from December 2007 to August 2009. All patients were tested for MRSA colonization and grouped according to results (MRSA+, methicillin-sensitive S. aureus [MSSA]+, and negative). Data analyzed included demographics, incidence of SSI, and wound culture results.

Results

A total of 1,137 patients were identified; 78.9 % negative, 14.7 % MSSA+, and 6.4 % MRSA+. The mean age was 59.5 years, 44.5 % of the patients were men, and 47.9 % of the patients underwent colorectal operation. SSI was identified in 101 (8.9 %) patients and was higher in the MRSA+ group than the negative and MSSA+ groups (13.7 vs. 9.4 vs. 4.2 %; p < 0.05). Although MRSA colonization had an odds ratio of 1.43 for developing an SSI, it was not a significant independent risk factor. However, the MRSA+ group was strongly associated with MRSA cultured from the wound when SSI was present (70 vs. 8.5 %; p < 0.0001).

Conclusions

MRSA colonization is not an independent risk factor for SSI following major GI operations; however, it is strongly predictive of MRSA-associated SSI in these patients. Preoperative MRSA nasal swab test with decolonization may reduce the incidence of MRSA-associated SSI after major GI surgery.

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Grant Support

No financial support was received for this study

Author information

Authors and Affiliations

  1. Department of Surgery, Texas A&M University System Health Science Center and Scott & White Memorial Hospital, 2401 South 31st Street, Temple, TX, 76508, USA

    Marcela C. Ramirez, Cara Govednik-Horny, Daniel Jupiter & Harry T. Papaconstantinou

  2. Department of Internal Medicine, Texas A&M University System Health Science Center and Scott & White Memorial Hospital, Temple, TX, USA

    Michelle Marchessault

Authors
  1. Marcela C. Ramirez
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  2. Michelle Marchessault
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  3. Cara Govednik-Horny
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  5. Harry T. Papaconstantinou
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Corresponding author

Correspondence to Harry T. Papaconstantinou.

Additional information

Discussant

Dr. Mark P. Callery (Boston, MA): Congratulations on providing us this first evaluation of how MRSA colonization impacts surgical site infections (SSIs) after elective gastrointestinal surgery. While case numbers are small and dwarfed compared to the reported infections caused by the usual pathogens of GI surgery, they do reveal that MRSA colonization strongly predicts MRSA-associated SSIs.

Did any of those infections occur in a cluster of any sort, such as across a tight time period, or perhaps related to a certain ward or other healthcare facility?

Going forward, should we alter our prevention and treatment strategies for SSIs in GI surgery based on these data? Beyond higher suspicions for MRSA, should we broaden prophylactic antibiotics, or open wounds sooner? Is uniform surveillance for patients or healthcare personnel for that matter needed, and if so, worth it from a cost standpoint? What if we were more compliant with hand hygiene to retard transmission, would that be enough? How have you changed your own practice?

Closing Discussant

Dr. Harry T. Papaconstantinou: Thank you Dr. Callery for your thoughtful review, comments, and questions. First, we did not identify any clustering of infections in terms of time period, ward, or healthcare provider. In terms of how we move forward given our study and data, I think we need to consider altering how we manage MRSA-colonized patients preoperatively. Although we do not do preoperative testing at our facility, I do review the chart to determine if the patient has had a previous MRSA infection or has had a previous positive nasal swab test. In those patients, I include vancomycin in the perioperative antibiotic prophylaxis and have a lower threshold for opening a wound I suspect is infected. I cannot comment on how this has affected outcomes. I have not reviewed our experience.

Uniform surveillance and isolation for patients with MRSA colonization as been implemented at many institutions including our own. Its success is dependent on minimizing the exposure and patient to patient transmission. Given that many hospital-acquired infections can carry a hefty cost, many studies have shown it is cost-effective. As for surveillance of healthcare personnel, I am not familiar with the data and cannot comment. Hand hygiene, on the other hand, is very important. It also decreases patient to patient transmission and has been shown to decrease hospital-acquired infections. Its success, however, is dependent upon completing the task. Many hospitals that survey hand washing (hand hygiene) report compliance rates much <100 %. I would hope that we, healthcare professionals, can do a better job in this respect.

It is clear that antibiotic-resistant organisms will play a significant role in surgical care. Our study provides knowledge on how MRSA colonization affects SSI following major GI surgery. If nasal colonization of MRSA is a strong predictor of organisms involved in SSI following these operations, we must investigate whether managing (eradicating) nasal colonization will have an impact. In our current healthcare climate, any study like that must include a comprehensive cost–benefit analysis to determine if implementation is cost-effective.

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Ramirez, M.C., Marchessault, M., Govednik-Horny, C. et al. The Impact of MRSA Colonization on Surgical Site Infection Following Major Gastrointestinal Surgery. J Gastrointest Surg 17, 144–152 (2013). https://doi.org/10.1007/s11605-012-1995-2

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  • DOI: https://doi.org/10.1007/s11605-012-1995-2

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