Previous Methicillin-Resistant Staphylococcus aureus Infection Independent of Body Site Increases Odds of Surgical Site Infection after Ventral Hernia Repair - 21/07/15
, Rebeccah B. Baucom, MD a, Melissa K. Stewart, MD a, Sharon E. Phillips, MSPH b, Michael D. Holzman, MD, MPH, FACS a, Jesse M. Ehrenfeld, MD, MPH c, Kenneth W. Sharp, MD, FACS a, William H. Nealon, MD, FACS a, Benjamin K. Poulose, MD, MPH, FACS aAbstract |
Background |
Methicillin-resistant Staphylococcus aureus infections can be difficult to manage in ventral hernia repair (VHR). We aimed to determine whether a history of preoperative MRSA infection, regardless of site, confers increased odds of 30-day surgical site infection (SSI) after VHR.
Study Design |
A retrospective cohort study of patients undergoing VHR with class I to III wounds between 2005 and 2012 was performed using Vanderbilt University Medical Center's Perioperative Data Warehouse. Preoperative MRSA status, site of infection, and 30-day SSI were determined. Univariate and multivariate analyses adjusting for confounding factors were performed to determine whether a history of MRSA infection was independently associated with SSIs.
Results |
A total of 768 VHR patients met inclusion criteria, of which 46% were women. There were 54 (7%) preoperative MRSA infections (MRSA positive); 15 (28%) soft tissue, 9 (17%) bloodstream, 4 (7%) pulmonary, 3 (6%) urinary, and 5 (9%) other. Overall SSI rate was 10% (n = 80), SSI rate in the MRSA-positive group was 33% (n = 18), compared with 9% (n = 62) in controls (p < 0.001). Multivariate analysis demonstrated that a history of MRSA infection significantly increased odds of 30-day SSI after VHR by 2.3 times (95% CI, 1.1-4.8; p = 0.035). Other factors associated with postoperative SSI were performance of myofascial release, increasing BMI, length of operation, open repair, and clean-contaminated wound classification.
Conclusions |
A history of site-independent MRSA infection confers significantly increased odds of 30-day SSI after VHR. Additional investigation is needed to determine perioperative treatment regimens that might decrease odds of SSI in VHR, and optimal prosthetic types and techniques for this population.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : EMR, LOS, OR, PDW, SSI, VHR, VUMC
Plan
| Disclosure Information: Nothing to disclose. |
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| Disclosures outside the score of this work: Dr Poulose received a grant from Bard-Davol and is paid as a consultant to Ariste Medical. Dr Holzman has been paid by private attorneys for expert testimony in malpractice cases. All other authors have nothing to disclose. |
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| Support: Ms Ousley received research support from the Medical Scholars Program at the Vanderbilt University School of Medicine, Nashville, TN. Dr Nealon received travel support from Vanderbilt University Medical Center. |
Vol 221 - N° 2
P. 470-477 - août 2015 Retour au numéro
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