The success of routine MRSA screening in vascular surgery: a nine year review

Abstract

Aim: Methicillin resistant Staphylococcus aureus (MRSA) infection in vascular patients is associated with increased morbidity and mortality. We investigated whether routine MRSA screening reduced complications related to MRSA infection.

Methods: Data was analysed for all MRSA positive (+ve) vascular patients admitted before (1996-2000) and after (2001-2004) routine MRSA screening was introduced. Outcome measures compared included wound infection, major limb amputation and mortality rates.

Results: There were 92 and 188 MRSA +ve patients in the pre- and postscreening periods, respectively. After the introduction of MRSA screening, MRSA wound infection in MRSA +ve elective admissions was significantly reduced from 55.6% (20/36) to 22.4% (15/67), (P=0.002, chi2 test); amputations were reduced from 27.8% (10/36) to 9% (6/67), P value 0.026, and mortality from 16.7% (6/36) to 9% (6/67), P value >0.05. In MRSA +ve emergency admissions wound infection was significantly reduced from 62.5% (35/56) to 43.8% (53/121), P value 0.042, amputations from 50% (28/56) to 38.8% (47/121), P value 0.26, and mortality from 25% (14/56) to 12.4% (15/121), P value 0.067.

Conclusions: While the incidence of MRSA infection continues to rise, we have successfully demonstrated that MRSA screening identifies patients at risk of serious complications and is associated with a reduction in these complications following both elective and emergency surgery. Routine screening of all vascular admissions should be part of the strategy to combat MRSA infection.