Methicillin-resistant Staphylococcus aureus in an Irish orthopaedic centre: a five-year analysis.
ABSTRACT This prospective five-year study analyses the impact of methicillin-resistant Staphylococcus aureus (MRSA) on an Irish orthopaedic unit. We identified 318 cases of MRSA, representing 0.76% of all admissions (41,971). A total of 240 (76%) cases were colonised with MRSA, while 120 (37.7%) were infected. Patients were admitted from home (218; 68.6%), nursing homes (72; 22.6%) and other hospitals (28; 8.8%). A total of 115 cases (36.6%) were colonised or infected on admission. Many patients were both colonised and infected at some stage. The length of hospital stay was almost trebled because of the presence of MRSA infection. Encouragingly, overall infection rates have not risen significantly over the five years of the study despite increased prevalence of MRSA. However, the financial burden of MRSA is increasing, highlighting the need for progress in understanding how to control this resistant pathogen more effectively.
- SourceAvailable from: ming-shium Hsieh[Show abstract] [Hide abstract]
ABSTRACT: Background Intramedullary nailing is widely accepted as the gold standard for most metaphyseal fractures of the long bones. Infections after intramedullary nailing have increased and cause recalcitrant metaphyseal osteomyelitis. Usually, multiple surgeries combined with adjuvant administration of local and systemic antibiotics are required to achieve infection control. The recurrence rate is still high and often causes poor limb function. Enhancement of local antibiotic concentrations through different delivery systems has been developed as an effective solution for eliminating musculoskeletal infections. Our study was conducted to evaluate the efficacy of antibiotic-loaded acrylic cement rods in managing infected intramedullary nailing. Methods Twelve patients with metaphyseal osteomyelitis following intramedullary nailing were enrolled. The causative organisms were identified in eight patients, including six methicillin-resistant Staphylococcus aureus, one methicillin-susceptible S aureus, and one methicillin-resistant S aureus and Prevotella intermedia mixed infection. All patients were treated with radical reaming debridement, copious intramedullary lavage, insertion of an impregnated acrylic cement rod, and systemic antibiotic administration. Results The average follow-up duration was 59.1 months. None of the 12 patients showed a relapse of infections. Four patients had nonunion of the old fracture site and received subsequent revisional internal fixation and bone grafting. All of them achieved solid bony union within 18 weeks. Conclusions Insertion of antibiotic-loaded acrylic cement rods combined with adequate debridement, lavage, and systemic antibiotic administration significantly contribute to infection control after intramedullary nailing.Journal of Experimental and Clinical Medicine 06/2011; 3(3):137-141.
Conference Paper: Environmental significance of harvesting wind power on the Alleghenies[Show abstract] [Hide abstract]
ABSTRACT: The paper discusses the environmental and social significance of wind powered electric generation on the Allegheny Mountains. The existing power generation capacity in four states surrounding the region is first described and statistical data is given to show the history of fuel mix and emissions. Environmental effects of the existing power generation facilities are discussed in terms of greenhouse gas emissions. The wind potential available in the region is described. Recent developments and planned wind power projects are presented with a discussion of their environmental impacts. The current policies and initiatives applicable to wind power in Pennsylvania, Maryland, West Virginia, and Virginia are compared and suggestions are made to promote the use of wind energy potential in the regionPower Engineering Society General Meeting, 2004. IEEE; 07/2004
- [Show abstract] [Hide abstract]
ABSTRACT: MRSA is a major economic and health issue internationally and as such is of particular importance in the appropriate management of orthopaedic patients. Bone, joint and implant infection can lead to unfavourable outcomes with a long protracted in hospital stay inevitable. The cost for the patient, the hospital and society are substantial. This study was a review of a prospectively maintained database from our unit over three time points from 2005 to 2007. At each time point a new infection control measure was implemented in an effort to reduce MRSA infections. Total rates of MRSA infection and colonisation in all orthopaedic patients were recorded, before and after separation of trauma and elective services, and after the introduction of a screening pre assessment clinic. 12259 orthopaedic patients were reviewed over the three years. The mean age of MRSA infected patients was 71. A higher proportion of female patients were infected than male patients. The mean length of stay for infected patients was 23.4 days. The rate of infection dropped from 0.49% in 2005 to 0.24%in 2007. After the introduction of these measures there was a substantial reduction in organ space and deep tissue infections. The separation of emergency and elective orthopaedic services coupled with effective pre-operative screening has resulted in a significant reduction in MRSA infection despite an ever increasing prevalance.The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 04/2012; 10(2):75-9. · 2.21 Impact Factor