Methicillin-resistant Staphylococcus aureus preventing strategy in cardiac surgery
Aikaterini Mastoraki 1*,
Ioannis Kriaras 1,
Evangelia Douka 1,
Sotiria Mastoraki 1,
Georgios Stravopodis 1,
Stephanos Geroulanos 1
1 Onassis Cardiac Surgery Center, Athens, Greece
* To whom correspondence should be addressed. E-mail: dr_kamast{at}yahoo.gr.
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Abstract |
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Objectives: The aim of this survey was to elucidate the efficacy of methicillin-resistant Staphylococcus aureus (MRSA) preventing strategy in our institution by investigating the incidence and evaluating the morbidity and mortality associated with this multi-resistant virulent organism. Methods: A prospective observational cohort among patients submitted to cardiovascular surgical procedures was conducted from 01/01/97 to 31/12/05. Preventing strategy included active screening programs by nasal swabs for all patients admitted from other hospitals or being at risk for developing infectious complications. Carriers or infected patients remained isolated and were treated promptly. Furthermore all newly employed health care workers were screened for MRSA and carriers were treated with mupirocin until the eradication of the pathogen. Results: Throughout the 9-year study period 826 infectious complications were registered among 15270 cardiac surgical patients. Total infection rate was 5.4%. MRSA was identified in 86 patients; 56 patients proved carriers and 30 infected. The MRSA associated infection rate was 0.2%. During this period of time mean ICU stay was 1.7 days and ICU mortality rate 2.9%. MRSA infected patients presented a mean ICU stay of 46.5 days and a mortality rate of 30%. In 10 patients MRSA was detected in tracheal secretions, in 4 patients in swabs taken from donor site infection and in 4 patients from superficial sternal surgical wound. In 10 patients the pathogen was isolated from cultures of the surgical site drainage and the diagnosis of post-sternotomy mediastinitis was confirmed. The remaining 2 patients were defined as having severe sepsis; MRSA was documented in central venous catheter tips and blood cultures. Conclusions: The prompt determination, isolation and appropriate treatment of MRSA patients admitted from other institutions combined with the detection and elimination of carriers among new health care workers and patients at high risk of developing infectious complications prevented further spread of the pathogen. Keywords: MRSA; Preventing strategy; Cardiac surgery
