Review of MRSA screening and antibiotics prophylaxis in orthopaedic trauma patients; The risk of surgical site infection with inadequate antibiotic prophylaxis in patients colonized with MRSA

H J Iqbal; N Ponniah; S Long; N Rath; M Kent

doi:10.1016/j.injury.2017.04.012

Review of MRSA screening and antibiotics prophylaxis in orthopaedic trauma patients; The risk of surgical site infection with inadequate antibiotic prophylaxis in patients colonized with MRSA

Injury. 2017 Jul;48(7):1382-1387. doi: 10.1016/j.injury.2017.04.012. Epub 2017 Apr 13.

Authors

H J Iqbal¹, N Ponniah², S Long², N Rath³, M Kent²

Affiliations

¹ Trauma and Orthopaedic department, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK. Electronic address: hafjavaid@yahoo.com.
² Trauma and Orthopaedic department, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK.
³ Trauma and Orthopaedic department, University Hospital of wales, Cardiff, UK.

PMID: 28473167
DOI: 10.1016/j.injury.2017.04.012

Abstract

Aims: The primary aim of this study was to determine whether orthopaedic trauma patients receive appropriate antibiotic prophylaxis keeping in view the results of their MRSA screening. The secondary aim was to analyse the risk of developing MRSA surgical site infection with and without appropriate antibiotic prophylaxis in those colonized with MRSA.

Patients and methods: We reviewed 400 consecutive orthopaedic trauma patient episodes. Preoperative MRSA screening results, operative procedures, prophylactic antibiotics and postoperative course were explored. In addition to these consecutive patients, the hospital MRSA database over the previous 5 years identified 27 MRSA colonized acute trauma patients requiring surgery.

Results: Of the 400 consecutive patient episodes, 395(98.7%) had MRSA screening performed on admission. However, in 236 (59.0%) cases, the results were not available before the surgery. Seven patient episodes (1.8%) had positive MRSA colonization. Analysis of 27 MRSA colonized patients revealed that 20(74%) patients did not have the screening results available before the surgery. Only 5(18.5%) received Teicoplanin and 22(81.4%) received cefuroxime for antibiotic prophylaxis before their surgery. Of those receiving cefuroxime, five (22.73%) patients developed postoperative MRSA surgical site infection (SSI) but none of those (0%) receiving Teicoplanin had MRSA SSI. The absolute risk reduction for SSI with Teicoplanin as antibiotic prophylaxis was 22.73% (CI=5.22%-40.24%) and NNT (Number Needed to Treat) was 5 (CI=2.5-19.2) CONCLUSION: Lack of available screening results before the surgery may lead to inadequate antibiotic prophylaxis increasing the risk of MRSA surgical site infection. Glycopeptide (e.g.Teicoplanin) prophylaxis should be considered when there is history of MRSA colonization or MRSA screening results are not available before the surgery.

Keywords: Glycopeptide antibiotics; MRSA screening; Methicillin resistant staphylococcus aureus; Surgical site infection; Trauma surgery.

MeSH terms

Adult
Aged
Aged, 80 and over
Antibiotic Prophylaxis*
Colony Count, Microbial
Drug Administration Schedule
Female
Fracture Fixation, Internal / adverse effects*
Fractures, Bone / surgery*
Humans
Male
Methicillin-Resistant Staphylococcus aureus / drug effects*
Middle Aged
Postoperative Complications / microbiology
Postoperative Complications / prevention & control*
Preoperative Care
Retrospective Studies
Risk Assessment
Staphylococcal Infections / microbiology
Staphylococcal Infections / prevention & control*
Surgical Wound Infection / microbiology
Surgical Wound Infection / prevention & control*
United Kingdom