Watters K, O'dwyer T P, Rowley H
Department of Otolaryngology, Mater Hospital, Eccles St, Dublin, Ireland.
J Laryngol Otol. 2004 Sep;118(9):694-9. doi: 10.1258/0022215042244732.
Methicillin resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial pathogen worldwide. The objectives of this study were to assess the morbidity and cost associated with the treatment of head and neck cancer patients who become colonized or infected with MRSA following major surgical procedures. We present a retrospective review of patients who underwent major surgery for head and neck cancer over a one year period and who then became MRSA positive in the post-operative period. MRSA affected 25/55 (45 per cent) patients who underwent major head and neck procedures during the period studied. The mean time of diagnosis was 13 days post-surgery. Morbidity included cellulitis, osteomyelitis and MRSA pneumonia. Thirteen of the patients who became MRSA positive (52 per cent of the MRSA group) required further surgery including plate removal, new flap formation and wound debridement as a result of the infection. Average in-hospital stay was almost three times more prolonged for patients who became MRSA positive compared to those who did not have MRSA. The costs of the first hospital stay were over three times more in the MRSA-positive group of patients. Antibiotic costs were increased by pound 2470 per patient because of MRSA. The extra stay in hospital, together with extra days in intensive care, extra medical and nursing care and additional costly antibiotic treatment, led to major cost implications and loss of health service resources in the unit. MRSA infection is a serious cause of morbidity in any surgical group of patients and this study focuses on the consequences for treatment of head and neck cancer patients in particular.
耐甲氧西林金黄色葡萄球菌（MRSA）已成为全球普遍存在的医院病原体。本研究的目的是评估在接受大手术后发生MRSA定植或感染的头颈癌患者的发病率及治疗成本。我们对在一年时间内接受头颈癌大手术且术后MRSA呈阳性的患者进行了回顾性研究。在所研究期间，接受头颈大手术的55名患者中有25名（45%）感染了MRSA。诊断的平均时间为术后13天。发病情况包括蜂窝织炎、骨髓炎和MRSA肺炎。13名MRSA呈阳性的患者（占MRSA组的52%）因感染需要进一步手术，包括取出钢板、形成新的皮瓣和伤口清创。与未感染MRSA的患者相比，MRSA呈阳性的患者平均住院时间延长了近三倍。MRSA呈阳性的患者组首次住院费用高出三倍多。由于MRSA，每位患者的抗生素费用增加了2470英镑。额外的住院时间，加上在重症监护室的额外天数、额外的医疗和护理以及额外的昂贵抗生素治疗，导致该科室产生重大成本影响并造成卫生服务资源的损失。MRSA感染是任何手术患者群体发病的严重原因，本研究尤其关注其对头颈癌患者治疗的影响。
