The Long Term Outcome of MRSA Infection in Elective Orthopaedic Surgery a Longitudinal Population Study in a District Hospital

Abstract

Discussion References

This study looked at long term morbidity and mortality prospectively following MRSA infection over an 18 year period in patients undergoing elective surgery in a 600 bedded district general hospital. A database identified 36 cases following elective surgery (21 hip replacements, 14 knee replacements and 1 shoulder) from 1994 when the first case occurred until the end of June 2012 with a mean follow up period of 14.2 (0.4-18.1) years. MRSA occurred in 0.0012% of all our admissions within the hospital with 0.005% of hip and knee replacements. Nine (0.0012%) of the joint replacements (5 hips and 4 knees) undergoing two stage revision surgery for deep MRSA infection in comparison to twenty eight (0.0025%) revisions for deep infections from other organisms in 7,203 cases over 18 years. In our study there was an increase in the mortality at 6% in patients who had an MRSA infection and 5% in other infected cases. This was six times higher than the baseline rate for the unit as a whole. Having an MRSA infection in hospital delayed the discharge of the patient by an average of 8.2 days and 29 (81%) of the 36 cases required further surgery to control the effects of the infection at the surgical site. The chance of further surgery was 24% higher than for joint replacements infected with other organisms in the same period and double the rate of local flaps were required in knee replacements than for other infections. The presence of multiple co-morbidities appeared in those requiring further interventions especially diabetes, immunosuppression, cardiac and respiratory compromise. This may have accounted the excess mortality. Superficial infections did not affect a patient’s functional score in the long run but patients requiring more than one washout had a higher morbidity, limited mobility, often multiple operations and a much worst psychological outcome with high levels of anxiety and depression. Introduction of pre-operative screening has reduced the risk of infection. Continued vigilance is required to prevent this infection and its long term sequelae particularly in those with multiple co-morbidities.