Cowie Scott E, Ma Irene, Lee Susan K, Smith R Matthew, Hsiang York N
Department of General Surgery, University of British Columbia, Vancouver, British Columbia.
Vasc Endovascular Surg. 2005 Jul-Aug;39(4):327-34. doi: 10.1177/153857440503900404.
Although methicillin-resistant Staphylococcus aureus (MRSA) infection is a worldwide problem, data on its significance among vascular surgery patients remain scant and conflicting. This study was designed to evaluate the association between nosocomial MRSA infection and patient outcome following vascular surgery procedures. Outcomes among patients with MRSA infection were also compared to those infected with methicillin-sensitive Staphylococcus aureus (MSSA). All patients admitted to a tertiary care Vascular Surgery ward during the year 2002 were included in this retrospective review. In addition to information on demographic and comorbid conditions, data on surgical interventions, nosocomial infection incidence rates as defined by the Center for Disease Control guidelines, and MRSA screening results were collected. Primary outcome was in-hospital death. Secondary outcomes measures included length of hospital stay, readmissions, or repeat surgeries, and ICU admissions. Of a total of 408 subjects, 110 were documented with a nosocomial infection (27.0%). Of these, 16 patients (3.9%) were colonized with MRSA on screening at time of admission, 22 (5.4%) had acquired MRSA infection during hospitalization, and 15 (3.7%) had MSSA infection. Patients with MRSA, MSSA, and non-MRSA infection had similar baseline characteristics except for hypertension and tobacco use. Age and MRSA infection were significant risk factors for in-hospital deaths (OR 1.07, 95% CI 1.01-1.13, p = 0.01 and OR 7.44, 95% CI 1.63-33.9, p = 0.01, respectively). Adjusted for the effects of age, MRSA infection remained a significant independent risk factor associated with in-hospital deaths (OR 4.38, 95% CI 1.09-17.7, p = 0.04). After adjustment for baseline risk factors, MRSA infection was also independently associated with secondary outcome measures. Although risks of non-MRSA infections were also associated with adverse outcomes in the multivariate analyses, MRSA posed higher risks, as reflected by higher odds ratio in all instances. The 22 patients with documented MRSA infection had significantly longer hospital stays than those with MSSA infection (median 24 days vs 8 days, p = 0.02). However, no significant differences were noted between the 2 groups in terms of secondary outcome. These results show that MRSA infection is a significant risk factor for adverse clinical outcomes among patients undergoing vascular surgery procedures. Infection with MRSA results in a greater risk of these outcomes when compared with non-MRSA infection. However, despite concerns regarding the virulence of this strain of staphylococcus, patients infected with MRSA had no higher rates of morbidity or mortality except for increased length of hospital stay when compared to patients with MSSA.
尽管耐甲氧西林金黄色葡萄球菌（MRSA）感染是一个全球性问题，但关于其在血管外科患者中的重要性的数据仍然匮乏且相互矛盾。本研究旨在评估医院获得性MRSA感染与血管外科手术后患者结局之间的关联。还将MRSA感染患者的结局与甲氧西林敏感金黄色葡萄球菌（MSSA）感染患者的结局进行了比较。2002年入住三级护理血管外科病房的所有患者均纳入本回顾性研究。除了收集人口统计学和合并症信息外，还收集了手术干预、疾病控制中心指南定义的医院感染发病率以及MRSA筛查结果的数据。主要结局是住院死亡。次要结局指标包括住院时间、再次入院或再次手术以及重症监护病房（ICU）入院情况。在总共408名受试者中，有110人记录有医院感染（27.0%）。其中，16例患者（3.9%）入院筛查时MRSA定植，22例（5.4%）住院期间获得MRSA感染，15例（3.7%）有MSSA感染。除高血压和吸烟外，MRSA、MSSA和非MRSA感染患者的基线特征相似。年龄和MRSA感染是住院死亡的重要危险因素（分别为OR 1.07，95%CI 1.01 - 1.13，p = 0.01和OR 7.44，95%CI 1.63 - 33.9，p = 0.01）。调整年龄影响后，MRSA感染仍然是与住院死亡相关的重要独立危险因素（OR 4.38，95%CI 1.09 - 17.7，p = 0.04）。在调整基线危险因素后，MRSA感染也与次要结局指标独立相关。尽管在多变量分析中非MRSA感染的风险也与不良结局相关，但MRSA带来的风险更高，所有情况下比值比均更高。22例记录有MRSA感染的患者住院时间明显长于MSSA感染患者（中位数24天对8天，p = 0.02）。然而，两组在次要结局方面未观察到显著差异。这些结果表明，MRSA感染是接受血管外科手术患者不良临床结局的重要危险因素。与非MRSA感染相比，MRSA感染导致这些结局的风险更大。然而，尽管对这种葡萄球菌菌株的毒力存在担忧，但与MSSA感染患者相比，MRSA感染患者除住院时间延长外，发病率和死亡率并未更高。
