Murphy G J, Pararajasingam R, Nasim A, Dennis M J, Sayers R D
Department of Vascular Surgery, Leicester General Hospital NHS Trust, Gwendolen Road, Leicester LE5 4PW, UK.
Ann R Coll Surg Engl. 2001 May;83(3):158-63.
Methicillin-resistant Staphylococcus aureus (MRSA) infection is emerging as a major problem in vascular surgical practice. The aim of this study was to review the management of patients with MRSA infection complicating vascular surgical operations.
Data were obtained from the vascular audit, case notes, intensive therapy unit (ITU) notes, high dependency unit (HDU) notes and microbiological records of patients who underwent either arterial reconstruction (n = 464) or limb amputation (n = 110) between April 1994 and October 1998.
Forty-nine vascular surgical patients developed clinical MRSA infection (9%). Clinical MRSA infection in patients who had undergone aorto-iliac reconstruction (n = 18) was associated with a 56% mortality (n = 10) and the most common infections were bacteraemia (55%) and pneumonia (50%). MRSA infection occurred in 17 patients who had undergone infra-inguinal bypass and was associated with a 29% mortality (n = 5). The most common site of MRSA infection was the groin wound (76%) leading to anastomotic dehiscence and death in one patient (11%) and necessitating wound debridement in 4 patients (22%). MRSA infection of the groin wound in the presence of a prosthetic graft (n = 3) led to anastomotic dehiscence in 2 patients, and graft excision in 2 patients. Similar complications were not observed in the presence of an underlying autogeneous long saphenous vein graft (n = 16). MRSA infection following major lower limb amputation (n = 14) was associated with death in 5 patients (36%). Wound infection in 10 amputees (71%) led to revision of the amputation to a higher level in 2 (14%) and wound debridement in 2 (14%).
MRSA infection has a high mortality in vascular surgical patients in general, and following aorto-iliac reconstruction in particular. Autogeneous vein may confer some protection against local complications following groin wound infection. Strategies aimed at reducing the incidence of infection, including strict adherence to infection control procedures, may reduce the severity of this problem.
耐甲氧西林金黄色葡萄球菌（MRSA）感染正成为血管外科手术中的一个主要问题。本研究的目的是回顾血管外科手术并发MRSA感染患者的管理情况。
数据来自1994年4月至1998年10月期间接受动脉重建（n = 464）或肢体截肢（n = 110）患者的血管审计、病历、重症监护病房（ITU）记录、高依赖病房（HDU）记录和微生物学记录。
49例血管外科患者发生临床MRSA感染（9%）。接受主-髂动脉重建术（n = 18）的患者发生临床MRSA感染，死亡率为56%（n = 10），最常见的感染是菌血症（55%）和肺炎（50%）。17例接受腹股沟下旁路手术的患者发生MRSA感染，死亡率为29%（n = 5）。MRSA感染最常见的部位是腹股沟伤口（76%），导致1例患者（11%）吻合口裂开和死亡，4例患者（22%）需要伤口清创。人工血管存在时腹股沟伤口的MRSA感染（n = 3）导致2例患者吻合口裂开，2例患者人工血管切除。在存在自体大隐静脉移植的情况下（n = 16）未观察到类似并发症。下肢大截肢术后（n = 14）的MRSA感染与5例患者（36%）死亡相关。10例截肢患者（71%）的伤口感染导致2例（14%）截肢水平提高，2例（14%）伤口清创。
一般而言，MRSA感染在血管外科患者中死亡率较高，尤其是在主-髂动脉重建术后。自体静脉可能对腹股沟伤口感染后的局部并发症有一定的保护作用。旨在降低感染发生率的策略，包括严格遵守感染控制程序，可能会减轻这一问题的严重程度。
