Methicillin-resistant Staphylococcus aureus in orthopaedic trauma: Identification of risk factors as a strategy for control of infection

The Edinburgh Orthopaedic Trauma Unit, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
The Bone & Joint Journal (Impact Factor: 3.31). 03/2009; 91(2):249-52. DOI: 10.1302/0301-620X.91B2.21339
Source: PubMed


We have conducted a case-control study over a period of ten years comparing both deep infection with methicillin-resistant staphylococcus aureus (MRSA) and colonised cases with a control group. Risk factors associated with deep infection were vascular diseases, chronic obstructive pulmonary disease, admission to a high-dependency or an intensive-care unit and open wounds. Those for colonisation were institutional care, vascular diseases and dementia. Older age was a risk factor for any MRSA infection. The length of hospital stay was dramatically increased by deep infection. These risk factors are useful in identifying higher-risk patients who may be more susceptible to MRSA infection. A strategy of early identification and isolation may help to control its spread in trauma units.

    • "This effect was not seen in the lumbar surgery groups, suggesting that pulmonary complications after spine surgery depend on the distance of the procedure site from the upper airways. COPD patients also have an increased risk of postoperative infection, including pneumonia and wound infection.891115–16 This is why postoperative antibiotics are unhesitantly indicated for these patients.18 "
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) and obesity may be more common among spine surgery patients than in the general population and may affect hospital cost. We retrospectively studied the prevalence of COPD and obesity among 605 randomly selected spine surgery inpatients operated between 2005 and 2008, including lumbar microdiskectomy, anterior cervical decompression and fusion and lumbar decompression and fusion patients. The length of hospital stay and hospital charges for patients with and without COPD and obesity (body mass index [BMI]≥30 kg/m(2)) were compared. Among 605 spine surgery patients, 9.6% had a history of COPD. There were no statistical difference in the prevalence of COPD between the three spine surgery groups. Obesity was common, with 47.4% of the patients having a BMI≥30 kg/m(2). There were no significant differences in obesity rates or BMI values between the three types of spine surgery patients. Obesity rates between patients with and without COPD were 62.1% vs. 45.9%, and were statistically different (P<0.05). Similarly, significant difference (P<0.01) in BMI values between COPD and non-COPD groups, 32.66±7.19 vs. 29.57±6.048 (mean ± std. deviation), was noted. There was significant difference (P<0.01) in cost between nonobese female patients without COPD and those with obesity and COPD in the anterior cervical decompression and fusion (ACDF) group. No association with increased hospital length of stay or cost was found in the other two types of spine surgery or in male ACDF patients. COPD and obesity seem to additively increase the length of hospital stay and hospital charges in ACDF female patients, an important finding that requires further investigation.
    No preview · Article · Oct 2010 · Indian Journal of Orthopaedics
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    • "Patients with MRSA have a significantly longer in-hospital stay, a worse prognosis and higher mortality. They also instigate higher costs in their diagnosis and therapy, are subject to social stigma and suffer from greater psychological stress [5], [6], [7], [8], [9], [10], [11], [12]. "
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    ABSTRACT: Background: The continually rising number of hospital acquired infections and particularly MRSA (Methicillin-resistant Staphylococcus aureus) colonization poses a major challenge from both clinical and epidemiological perspectives. The assessment of risk factors is vital in determining the best prevention, diagnosis and treatment strategies. Materials and methods: We analyzed 798 cases of MRSA in a large German University Hospital over a 7-year period. Data was collected retro- and prospectively including patient age, sex, type of ward and duration of inpatient stay. In addition we analyzed all cases on ICU with regards to cross infection and MRSA genotyping via DNA MicroArray Technology. The years 2004 to 2007 were analyzed with a specific focus on gender. Results: Male gender is significantly correlated with increased risk of MRSA acquisition (p<0.001), the predominant setting for MRSA is on ICU. 75% of the MRSA positive patients are over 50 years of age (average age 59.8 years). The inpatient time was 4.15 times higher in MRSA carriers compared with non-MRSA cases, however this was not significant. MRSA genotyping on ICU showed mainly the subtypes ST 5, ST 22, ST 228, however cross contamination with identical genotypes was only detected in a minority of cases (5 out of 22). Conclusion: Unlike previous studies which show no or inconclusive evidence of gender as a risk factor, our data confirm that male gender is a significant risk factor for MRSA carrier status. Further research will be required to investigate the aetiology of these findings.
    Full-text · Article · Sep 2010
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    ABSTRACT: The paper presents an adaptive backstepping approach for systems in strict-feedback form using multilayered, nonlinear-in-the-parameters neural networks. A benefit this approach is that the construction of the controller is greatly simplified by obviating the need to construct a regressor or basis functions for the neural network. In addition the network is adapted solely online, with no off-line training. The neural network architecture is very simple, and scales easily with the number of backward steps taken in the control design.
    No preview · Conference Paper · Feb 2002
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