OTA 2006 Posters
Scientific Poster #101 Geriatrics
Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA)
in Trauma Orthopaedics: Colonization and Deep Infection
Daniel T. M. Fascia, MBChB, BSc (n); Aran Singanayagam, MBChB, BSc (*);
John F. Keating, MD (n); The Edinburgh Orthopaedic Trauma Unit, The
Royal Infirmary of Edinburgh, Scotland, United Kingdom
Purpose: MRSA represents a growing problem in the trauma population.
Despite the increase in both colonization and deep infection rates in trauma
patients, no population-specific risk factors specific have been identified.
The purpose of the present study was to identify risk factors for MRSA colonization
and deep infection.
Methods: A prospective trauma database of 32,370 consecutive admissions
was analyzed for MRSA infection. A case-control study compared all 141 deep
MRSA infections to an equal and comparable number of randomly selected normal
controls from the same population. A second comparison group of colonized
patients was analyzed to determine whether the risk factors were specific
to deep infection alone or also applicable to asymptomatic carriers
Results: The risk factors for MRSA colonization were increasing age
(P <0.001), dementia (P <0.001), vascular disease (P
= 0.013), and institutional care residence prior to admission (P
<0.001). The risk factors for deep MRSA infection were increasing age
(P <0.001), vascular disease (P <0.001), malignancy
(P = 0.01), rheumatologic diseases (P = 0.01), chronic obstructive
pulmonary disease (COPD) (P <0.001), smoking (P <0.028),
open wounds (P = 0.001) and intensive care/high-dependency admission
(P = 0.01). Patients with deep MRSA infection spend a mean of 10
days longer as a hospital inpatient during the year preceding diagnosis
than their colonized counterparts (P <0.01), implicating hospitalization
as a risk factor for deep infection.
Conclusions/Significance: Older age, prolonged hospitalization, open
wounds, malignancy, and institutional residence have already been identified
as general population risk factors for MRSA. Our study confirms their role
in the trauma population. In addition, we have identified that vascular
disease, rheumatologic diseases, COPD, smoking, and high-dependency admission
are risk factors for deep infection. These risk factors may be used to identify
high-risk patients and to plan targeted screening and therapy for MRSA colonization.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.