Article Data

  • Views 579
  • Dowloads 133

Original Research

Open Access

Methicillin-Resistant Staphylococcus Species in a cardiac surgical intensive care unit

  • MARINA PIERI1
  • GIOVANNI LANDONI1
  • MASSIMO ZAMBON1
  • DAIANA TADDEO1
  • ROBERTO ASCARI1
  • MARCO COSTANTINI1
  • FABRIZIO MONACO1
  • ANNA MARA SCANDROGLIO1
  • FEDERICO PAPPALARDO1
  • TIZIANA BOVE1
  • MARIA GRAZIA CALABRÒ1
  • GIOVANNI MARINO1
  • ALBERTO ZANGRILLO1

1,Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute

DOI: 10.22514/SV102.122015.5 Vol.10,Issue 2,December 2015 pp.65-68

Published: 14 December 2015

*Corresponding Author(s): GIOVANNI LANDONI E-mail: landoni.giovanni@hsr.it

Abstract

Objective. Multi-drug resistant bacterial infections, in particular when Methicillin-Resistant Staphylococcus Aureus (MRSA) is involved, have become a relevant problem in both general and specialized intensive care units. The aim of this study was to identify the epidemiology of MRSA infections in a Cardiac Surgical Intensive Care Unit, to assess their impact on mortality and to identify predictors of MRSA infection and mortality in this population.

Design and settings. A 7-year observational study in a cardiac surgery teaching center.

Participants. Eight thousand, one hundred and sixty-two microbiological samples were obtained from 7,313 patients who underwent cardiac surgery in the study period.

Interventions. None.

Variables of interest and main results. Twenty-eight patients (0.38%) had MRSA infection. The most frequent site of MRSA isolation was from bronchoalveolar samples. Hospital mortality was 50% in patients with MRSA infection and 2% in patients without MRSA infection (p<0.001).

Few preoperative independent predictors of MRSA infection and hospital mortality were found at multivariate analysis. Outcomes were found to be most influenced by perioperative variables. MRSA infection was the strongest predictor of mortality, with an odds ratio of 20.5 (95% CI 4.143-101.626).

Conclusions. Methicillin-resistant Staphylococcus aureus infections following cardiac surgery still have a strong impact on the patients’ outcome. More efforts should be directed toward the development of new risk analysis models that might implement health care practices and might become precious instruments for infection prevention and control.

Keywords

Methicillin-Resistant Staphylococcus Aureus, infections, cardiac surgery, mortality, intensive care, cardiac anaesthesia

Cite and Share

MARINA PIERI,GIOVANNI LANDONI,MASSIMO ZAMBON,DAIANA TADDEO,ROBERTO ASCARI,MARCO COSTANTINI,FABRIZIO MONACO,ANNA MARA SCANDROGLIO,FEDERICO PAPPALARDO,TIZIANA BOVE,MARIA GRAZIA CALABRÒ,GIOVANNI MARINO,ALBERTO ZANGRILLO. Methicillin-Resistant Staphylococcus Species in a cardiac surgical intensive care unit. Signa Vitae. 2015. 10(2);65-68.

References

1. Zangrillo A, Landoni G, Fumagalli L, Bove T, Bellotti F, Sottocorna O et al. Methicillin- Resistant Staphylococcus Species in a Cardiac surgical Intensive Care Unit: a 5- Year Experience. J Cardiothorac Vasc Anesth 2006 Feb;20(1):31-7.

2. European Centre for Prevention and Control. Surveillance Report: Surveillance of surgical site infections in Europe 2010-2011 [online]. 2013 Oct [cited 2014 September 28]; Available from:

URL:http://www.ecdc.europa.eu/en/publications/Publications/SSI-in-europe-2010-2011.pdf.

3. Gorlitzer M, Wagner F, Pfeiffer S, Folkmann S, Meinhart J, Fischlein T, et al. Prevention of sternal wound complications after sternotomy: results of a large prospective randomized multicentral trial. Interact Cardiovasc Thorac Surg 2013 Sep;17(3):515-22.

4. Schweizer M, Perenchevic E, McDanel J, Carson J, Formanek M, Hafner J, et al. Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac or orthopedic surgery: systematic review and meta- analysis. BMJ 2013 Jun 13;346:f2743.

5. Healy DG, Duignan E, Tolan M, Young VK , O’Connell B , McGovern E . Should cardiac surgery be delayed among carriers of methicillin-resistant Staphylococcus aureus to reduce methicillin- resistant Staphylococcus aureus- related morbidity by preoperative decolonization? Eur J Cardiothorac Surg 2011 Jan;39(1):68-74.

6. Huang SS, Septimus E, Kleinman K, Moody J, Hickok J, Avery TR, et al. Targeted versus Universal Decolonization to Prevent ICU Infection. N Engl J Med 2013 Jun 13;368(24):2255-65.

7. Derde LP, Cooper BS, Goossens H, Malhotra-Kumar S , Willems RJ , Gniadkowski M , et al. Intervention to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomized trial. Lancet Infect Dis 2014 Jan;14(1):31-9.

8. Bellomo R , Ronco C , Kellum JA , Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute Dialysis Quality Initiative workgroup . Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004 Aug;8(4):R204-12.

9. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976:16 (1):31-41.

10. 10. Ranucci M, Castelvecchio S, Conte M, Megliola G , Speziale G , Fiore F , et al. The easier, the better: age, creatinine, ejection fraction score for operative mortality risk stratification in a series of 29,659 patients undergoing elective cardiac surgery. J Thorac Cardiovasc Surg 2011 Sep;142(3):581-6.

11. Landoni G, Pasin L, Monti G, Cabrini L, Beretta L, Zangrillo A. Towards zero perioperative mortality. Heart, Lung and Vessels 2013;5(3): 133-6.

12. Kang CI 1, Song JH , Chung DR , Peck KR , Ko KS , Yeom JS , et al. Clinical impact of methicillin resistance on outcome of patients with Staphylococcus aureus infection. A stratified analysis according to underlying diseases and sites of infection in a large prospective cohort. J Infect 2010 Oct;61(4):299-306.

13. Finkelstein R , Rabino G , Mashiach T , Bar-El Y , Adler Z , Kertzman V , et al. Effect of preoperative Antibiotic Prophylaxis on Surgical Site Infections Complicating Cardiac Surgery. Infect Control Hosp Epidemiol 2014 Jan;35(1):69-74.

14. McKinnell JA,Miller LG, Eels SJ, Cui E, Huang SS. A systematic Literature Review and Meta- Analysis of factors Associated with Methicillin- Resistant Staphylococcus aureus Colonization at Time of Hospital or Intensive Care Unit Admission. Infect Control Hosp Epidemiol 2013 Oct;34(10):1077-86.

15. Yuengsrigul A, Chin TW, Nussbaum E. Immunosuppressive and cytotoxic effects of furosemide on human peripheral blood mononuclear cells. Ann Allergy Asthma Immunol 1999 Dec;83(6 Pt 1):559-66.

16. Mazzeffi M, Zivot J, Buchman T, Halkos M . In-hospital Mortality After Cardiac Surgery: Patient Characteristics, timing, and Association with Postoperative Lenght of Intensive Care Unit and Hospital Stay. Ann Thorac Surg 2014 Apr;97(4):1220-5.

17. Wolman RL, Nussmeier NA, Aggarwal A, Kanchuger MS, Roach GW, Newman MF, et al. Cerebral injury after cardiac surgery: identification of a group at extraordinary risk. Multicenter Study of Perioperative Ischemia Research Group (McSPI) and the Ischemia Research Education Foundation (IREF) Investigators. Stroke 1999 Mar;30(3):514-22.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top