Methicillin-resistant Staphylococcus aureus (MRSA) infection in lower extremity amputations – a gigantic health-care problem or a false alarm?
Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) poses not only an increasingly serious health-care problem but also a notoriously gigantic public issue. We aimed to evaluate whether MRSA infection is a significant negative predictive factor for amputation healing and morbidity, in comparison to non-MRSA infections.
Materials and Methods: A cross-sectional comparative study of all the lower extremity amputations during the 25-month study period to examine the influence of MRSA and non-MRSA infection on clinical outcome. Results were compared between MRSA- and non-MRSA-infected patients using Fisher’s exact test.
Results: During the two-year period, 171 patients underwent lower limb amputations for acute or chronic limb ischemia. Sixteen (9.3%) had documented wound infection; including 10 MRSA (62.5%), 2 methicillin-sensitive Staphylococcus aureus (12.5%), 2 Pseudomonas aeruginosa (12.5%), 1 coagulase-negative staphylococci (6.2%) and 1 enterococcus (6.2%). Patients with MRSA and non-MRSA infections were well matched in demographics, indication & level of amputation, duration of operation, American Society of Anesthetists (ASA) grades, and wound classification (p<0.05).
There was no death or morbidity observed within 30 day post-operative period in all groups within the study. Over a 28 months median follow-up (range 16-50 months), an overall survival of 93% was observed. Twelve patients (7%) died including one in MRSA group and 11 in no infection group.
Conclusion: MRSA infection does not adversely affect the clinical outcome in patients undergoing lower extremity amputations. Regardless of presence of MRSA bacteria; common infection control measures, thorough wound debridement, careful wound surveillance and judicial administration of antibiotics should be routinely applied to all patients.
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