| Surgical Site Infection by Methicillin-Resistant
Staphylococcus aureus after Cardiovascular Operations:
An Outbreak and Its Control |
(Department of Cardiovascular Surgery, Department
of Cardiology*, Department of General Medicine** and Department
of Pathology***, Iizuka Hospital, Iizuka, Japan)
| Masayoshi Umesue |
Hiromi Ando |
Fumio Fukumura |
| Ichirou Nagano |
Noriko Boku |
Satoshi Kimura |
| Jiro Tanaka |
Shuichi Okamatsu* |
Kenichi Nakamura** |
| Rumiko Yoshida*** |
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We encountered 15 cases of surgical
site infection (SSI) by Methicillin-resistant Staphylococcus
aureus (MRSA) among 153 patients who underwent a cardiovascular
operation in 2000. SSIs consisted of 5 mediastinal infections,
9 surface wound infections and 1 artificial graft infection after
an abdominal aortic surgery. All infected cases had been operated
on between June and December 2000. Eighty-three cases, which
underwent cardiovascular operations during this period, were
divided into SSI or no-SSI groups and their clinical data were
analyzed. The data included age, gender, preoperative diabetes,
urgency, preoperative usage of a device like Swan-Ganz catheter
or IABP, preoperative albumin level, preoperative physical state
by ASA score, National Nosocominal Infections Surveillance index,
duration of operation, usage of a cardiopulmonary bypass, duration
of bypass, type of operation, and number of distal anastomoses
in CABG operations. Multivariate analysis showed gender (male),
diabetes, and emergency operation as independent risk factors
for the incidence of SSI by MRSA. One patient, who suffered a
mediastinal infection after CABG, had confirmed as demonstrating
the colonization of MRSA in sputum preoperatively. Microbiological
screening of medical staff showed 2 of the 6 surgical doctors
and 3 of the 25 ward nurses exhibited colonization with MRSA.
DNA analysis of MRSA, harvested from 5 infected patients, indicated
at least 2 strains of MRSA and 1 of the 2 strains was identical
to the MRSA that was detected in a doctor. We applied prophylactic
measures with reference to the guideline for prevention of surgical
site infection announced by CDC in 1999, which included the following:
routine work-up of MRSA-colonization, and treatment of all MRSA
colonized patients and those undergoing emergency operations
with Mupirocin. Preoperative patients were isolated from MRSA-infected
or colonized patients. MRSA-colonized surgical personnel were
treated with Mupirocin ointment. Cephazoline was administered
shortly before and after the operation as a prophylactic antibiotic.
Vancomycin was added to Cephazoline in patients with a history
of MRSA-colonization or infection. Through hand washing before
and after daily contact with patients was emphasised to all medical
staff. SSI surveillance conducted by an infection control team
was implemented. After the introduction of the prophylactic measurements,
one MRSA-SSI was observed among 113 cases who underwent a cardiovascular
operation between January and September 2001.
Jpn. J. Cardiovasc. Surg. 34: 14-20 (2005) |
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