Mounting evidence supports universal surveillance for MRSA in preoperative patients.
K. Kavanagh, Said Abusalem
Aug 1, 2011
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2
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Journal
Journal of the American College of Surgeons
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Key Takeaway Key Takeaway: Universal screening for MRSA in preoperative patients is essential for effective prevention and treatment of surgical infections due to the high prevalence of MRSA in these patients.
Abstract
The thrust of the evidence-based review, “Universal screening for methicillin-resistant Staphyloccus aureus in surgical patients,” in the Journal of the American College of Surgeons in ecember 2010 was to comment on the conflicting data rearding universal screening for methicillin-resistant Staphylooccus aureus (MRSA) in the surgical patient. An article from he Journal of the American Medical Association (JAMA) by arbarth and colleagues was used as the selected article to illustrate the conclusions.The commentary used this article as supporting evidence for not performing universal screening. However, in the analysis the following interpretation was made, “Also, only 43% of patients in the intervention group actually had changes made to their perioperative antibiotics because of time needed to get MRSA test results back.” In contradistinction, the Methods section of the JAMA article stated that of 386 identified MRSA carriers, 120 (31%) were not identified until after surgical intervention because of time delay and the urgency of surgery. Of the remaining 266 patients, 151 did not receive antibiotic prophylaxis against MRSA (57%). What can possibly be concluded when 57% of carriers, who were identified before surgery, were not given MRSA prophylaxis? In addition, it was stated that “especially in abdominal surgery, surgeons were reluctant to add vancomycin to the standard prophylactic regimen.” There is no question that preoperative screening in emergency patients will not be as effective if the results are not known before surgery and aminioglycosides were not given preoperatively. This patient group needs to be separated out in any data analysis. In addition, as the JAMA article pointed out, all of the 26 patients detected during outpatient visits had decolonization treatment and adequate prophylaxis and none developed a MRSA surgical infection. The vast majority of patients undergoing surgery do so on an elective or semielective basis. At our local hospitals, 80% of the patients fall into this category.