Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery

Sanjeet Avtaar Singh; Kasra Shaikhrezai; Rajdev Singh Toor; Ahmed Al-Adhami; Sudeep Das De; Renzo Pessotto

doi:doi:10.11648/j.ijcts.20170303.12

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Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery

Sanjeet Avtaar Singh, Kasra Shaikhrezai, Rajdev Singh Toor, Ahmed Al-Adhami, Sudeep Das De, Renzo Pessotto

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 3, Issue 3)

Received: 8 June 2017 Accepted: 11 July 2017 Published: 16 August 2017

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Abstract

The problem of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and decolonisation strategies. Cardiac surgery unit admissions receive MRSA cultures from nares, skin, throat and wounds/groin, and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed. The study comprises 50 patients: 32 successfully decolonized/eradicated carriers and 18 unsuccessfully eradicated carriers. A comparison of pre-operative characteristics showed no statistically significant differences between the 2 groups with the exception for asthmatic patients, where there was only 3.1% of MRSA eradicated patients vs 22.2% in the unsuccessful eradication group (p=0.031). There was no difference between the operative patient data of both groups in hospital mortality, post-operative lengths of stay, ventilation time, post op IABP (intra-aortic balloon pump), post-operative complications, Cerebrovascular accidents and Transient Ischaemic attacks as well as long term complications were not statistically significant. However, there is a statistically significant difference between the use of post-operative antibiotics, with 72.2% of unsuccessfully MRSA eradicated patients requiring antibiotics postoperatively, compared to 40.6%, (p=0.032). Preoperative asthmatics were more likely to fail MRSA eradication/decolonisation. Post operatively MRSA eradication results in the reduction in postoperative antibiotic use.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 3, Issue 3)
DOI	10.11648/j.ijcts.20170303.12
Page(s)	18-22
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

MRSA Eradication, Cardiothoracic Surgery, Surgical Site Infection

References

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[2]	Barber M. Methicillin-Resistant Staphylococci and Hospital Infection. Postgrad Med J. 1964; 40: SUPPL: 178-81.
[3]	Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh HA, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005; 5(12): 751-62.
[4]	Eurosurveillance editorial t. ECDC publishes 2014 surveillance data on antimicrobial resistance and antimicrobial consumption in Europe. Euro Surveill. 2015; 20(46).
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[6]	Dumitrescu O, Lina G. What is the place of linezolid in the treatment of methicillin-resistant Staphylococcus aureus nosocomial pneumonia and complicated skin and soft tissue infections in Europe? Clin Microbiol Infect. 2014; 20 Suppl 4: 1-2.
[7]	Cimochowski GE, Harostock MD, Brown R, Bernardi M, Alonzo N, Coyle K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg. 2001; 71(5): 1572-8; discussion 8-9.
[8]	Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, et al. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect. 2006; 63 Suppl 1:S1-44.
[9]	Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE, et al. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother. 2006; 57(4): 589-608.
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[11]	Combes A, Trouillet JL, Baudot J, Mokhtari M, Chastre J, Gibert C. Is it possible to cure mediastinitis in patients with major postcardiac surgery complications? Ann Thorac Surg. 2001; 72(5): 1592-7.
[12]	Zangrillo A, Landoni G, Fumagalli L, Bove T, Bellotti F, Sottocorna O, et al. Methicillin-resistant Staphylococcus species in a cardiac surgical intensive care unit: a 5-year experience. J Cardiothorac Vasc Anesth. 2006; 20(1): 31-7.
[13]	Kalra L, Camacho F, Whitener CJ, Du P, Miller M, Zalonis C, et al. Risk of methicillin-resistant Staphylococcus aureus surgical site infection in patients with nasal MRSA colonization. Am J Infect Control. 2013; 41(12): 1253-7.
[14]	Cho OH, Baek EH, Bak MH, Suh YS, Park KH, Kim S, et al. The effect of targeted decolonization on methicillin-resistant Staphylococcus aureus colonization or infection in a surgical intensive care unit. Am J Infect Control. 2016; 44(5): 533-8.
[15]	Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002; 346(24): 1871-7.
[16]	Kalmeijer MD, Coertjens H, van Nieuwland-Bollen PM, Bogaers-Hofman D, de Baere GA, Stuurman A, et al. Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis. 2002; 35(4): 353-8.
[17]	Suzuki Y, Kamigaki T, Fujino Y, Tominaga M, Ku Y, Kuroda Y. Randomized clinical trial of preoperative intranasal mupirocin to reduce surgical-site infection after digestive surgery. Br J Surg. 2003; 90(9): 1072-5.
[18]	Harbarth S, Dharan S, Liassine N, Herrault P, Auckenthaler R, Pittet D. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 1999; 43(6): 1412-6.
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APA Style

Sanjeet Avtaar Singh, Kasra Shaikhrezai, Rajdev Singh Toor, Ahmed Al-Adhami, Sudeep Das De, et al. (2017). Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery. International Journal of Cardiovascular and Thoracic Surgery, 3(3), 18-22. https://doi.org/10.11648/j.ijcts.20170303.12

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ACS Style

Sanjeet Avtaar Singh; Kasra Shaikhrezai; Rajdev Singh Toor; Ahmed Al-Adhami; Sudeep Das De, et al. Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery. Int. J. Cardiovasc. Thorac. Surg. 2017, 3(3), 18-22. doi: 10.11648/j.ijcts.20170303.12

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AMA Style

Sanjeet Avtaar Singh, Kasra Shaikhrezai, Rajdev Singh Toor, Ahmed Al-Adhami, Sudeep Das De, et al. Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery. Int J Cardiovasc Thorac Surg. 2017;3(3):18-22. doi: 10.11648/j.ijcts.20170303.12

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@article{10.11648/j.ijcts.20170303.12,
  author = {Sanjeet Avtaar Singh and Kasra Shaikhrezai and Rajdev Singh Toor and Ahmed Al-Adhami and Sudeep Das De and Renzo Pessotto},
  title = {Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {3},
  number = {3},
  pages = {18-22},
  doi = {10.11648/j.ijcts.20170303.12},
  url = {https://doi.org/10.11648/j.ijcts.20170303.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20170303.12},
  abstract = {The problem of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and decolonisation strategies. Cardiac surgery unit admissions receive MRSA cultures from nares, skin, throat and wounds/groin, and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed. The study comprises 50 patients: 32 successfully decolonized/eradicated carriers and 18 unsuccessfully eradicated carriers. A comparison of pre-operative characteristics showed no statistically significant differences between the 2 groups with the exception for asthmatic patients, where there was only 3.1% of MRSA eradicated patients vs 22.2% in the unsuccessful eradication group (p=0.031). There was no difference between the operative patient data of both groups in hospital mortality, post-operative lengths of stay, ventilation time, post op IABP (intra-aortic balloon pump), post-operative complications, Cerebrovascular accidents and Transient Ischaemic attacks as well as long term complications were not statistically significant. However, there is a statistically significant difference between the use of post-operative antibiotics, with 72.2% of unsuccessfully MRSA eradicated patients requiring antibiotics postoperatively, compared to 40.6%, (p=0.032). Preoperative asthmatics were more likely to fail MRSA eradication/decolonisation. Post operatively MRSA eradication results in the reduction in postoperative antibiotic use.},
 year = {2017}
}

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TY  - JOUR
T1  - Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery
AU  - Sanjeet Avtaar Singh
AU  - Kasra Shaikhrezai
AU  - Rajdev Singh Toor
AU  - Ahmed Al-Adhami
AU  - Sudeep Das De
AU  - Renzo Pessotto
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PY  - 2017
N1  - https://doi.org/10.11648/j.ijcts.20170303.12
DO  - 10.11648/j.ijcts.20170303.12
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
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EP  - 22
PB  - Science Publishing Group
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AB  - The problem of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and decolonisation strategies. Cardiac surgery unit admissions receive MRSA cultures from nares, skin, throat and wounds/groin, and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed. The study comprises 50 patients: 32 successfully decolonized/eradicated carriers and 18 unsuccessfully eradicated carriers. A comparison of pre-operative characteristics showed no statistically significant differences between the 2 groups with the exception for asthmatic patients, where there was only 3.1% of MRSA eradicated patients vs 22.2% in the unsuccessful eradication group (p=0.031). There was no difference between the operative patient data of both groups in hospital mortality, post-operative lengths of stay, ventilation time, post op IABP (intra-aortic balloon pump), post-operative complications, Cerebrovascular accidents and Transient Ischaemic attacks as well as long term complications were not statistically significant. However, there is a statistically significant difference between the use of post-operative antibiotics, with 72.2% of unsuccessfully MRSA eradicated patients requiring antibiotics postoperatively, compared to 40.6%, (p=0.032). Preoperative asthmatics were more likely to fail MRSA eradication/decolonisation. Post operatively MRSA eradication results in the reduction in postoperative antibiotic use.
VL  - 3
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Author Information

Sanjeet Avtaar Singh

Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
Kasra Shaikhrezai

Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
Rajdev Singh Toor

Department of Anesthesiology, Fiona Stanley Hospital, Murdoch, Australia
Ahmed Al-Adhami

Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
Sudeep Das De

Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
Renzo Pessotto

Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK

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APA Style

Sanjeet Avtaar Singh, Kasra Shaikhrezai, Rajdev Singh Toor, Ahmed Al-Adhami, Sudeep Das De, et al. (2017). Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery. International Journal of Cardiovascular and Thoracic Surgery, 3(3), 18-22. https://doi.org/10.11648/j.ijcts.20170303.12

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ACS Style

Sanjeet Avtaar Singh; Kasra Shaikhrezai; Rajdev Singh Toor; Ahmed Al-Adhami; Sudeep Das De, et al. Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery. Int. J. Cardiovasc. Thorac. Surg. 2017, 3(3), 18-22. doi: 10.11648/j.ijcts.20170303.12

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AMA Style

Sanjeet Avtaar Singh, Kasra Shaikhrezai, Rajdev Singh Toor, Ahmed Al-Adhami, Sudeep Das De, et al. Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery. Int J Cardiovasc Thorac Surg. 2017;3(3):18-22. doi: 10.11648/j.ijcts.20170303.12

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@article{10.11648/j.ijcts.20170303.12,
  author = {Sanjeet Avtaar Singh and Kasra Shaikhrezai and Rajdev Singh Toor and Ahmed Al-Adhami and Sudeep Das De and Renzo Pessotto},
  title = {Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {3},
  number = {3},
  pages = {18-22},
  doi = {10.11648/j.ijcts.20170303.12},
  url = {https://doi.org/10.11648/j.ijcts.20170303.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20170303.12},
  abstract = {The problem of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and decolonisation strategies. Cardiac surgery unit admissions receive MRSA cultures from nares, skin, throat and wounds/groin, and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed. The study comprises 50 patients: 32 successfully decolonized/eradicated carriers and 18 unsuccessfully eradicated carriers. A comparison of pre-operative characteristics showed no statistically significant differences between the 2 groups with the exception for asthmatic patients, where there was only 3.1% of MRSA eradicated patients vs 22.2% in the unsuccessful eradication group (p=0.031). There was no difference between the operative patient data of both groups in hospital mortality, post-operative lengths of stay, ventilation time, post op IABP (intra-aortic balloon pump), post-operative complications, Cerebrovascular accidents and Transient Ischaemic attacks as well as long term complications were not statistically significant. However, there is a statistically significant difference between the use of post-operative antibiotics, with 72.2% of unsuccessfully MRSA eradicated patients requiring antibiotics postoperatively, compared to 40.6%, (p=0.032). Preoperative asthmatics were more likely to fail MRSA eradication/decolonisation. Post operatively MRSA eradication results in the reduction in postoperative antibiotic use.},
 year = {2017}
}

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TY  - JOUR
T1  - Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery
AU  - Sanjeet Avtaar Singh
AU  - Kasra Shaikhrezai
AU  - Rajdev Singh Toor
AU  - Ahmed Al-Adhami
AU  - Sudeep Das De
AU  - Renzo Pessotto
Y1  - 2017/08/16
PY  - 2017
N1  - https://doi.org/10.11648/j.ijcts.20170303.12
DO  - 10.11648/j.ijcts.20170303.12
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 18
EP  - 22
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20170303.12
AB  - The problem of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and decolonisation strategies. Cardiac surgery unit admissions receive MRSA cultures from nares, skin, throat and wounds/groin, and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed. The study comprises 50 patients: 32 successfully decolonized/eradicated carriers and 18 unsuccessfully eradicated carriers. A comparison of pre-operative characteristics showed no statistically significant differences between the 2 groups with the exception for asthmatic patients, where there was only 3.1% of MRSA eradicated patients vs 22.2% in the unsuccessful eradication group (p=0.031). There was no difference between the operative patient data of both groups in hospital mortality, post-operative lengths of stay, ventilation time, post op IABP (intra-aortic balloon pump), post-operative complications, Cerebrovascular accidents and Transient Ischaemic attacks as well as long term complications were not statistically significant. However, there is a statistically significant difference between the use of post-operative antibiotics, with 72.2% of unsuccessfully MRSA eradicated patients requiring antibiotics postoperatively, compared to 40.6%, (p=0.032). Preoperative asthmatics were more likely to fail MRSA eradication/decolonisation. Post operatively MRSA eradication results in the reduction in postoperative antibiotic use.
VL  - 3
IS  - 3
ER  -

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