MRSA Infections Increasing in All Surgical Fields

A newly published study of four cases of MRSA (methicillin-resistant Staphylococcus aureus) infection in patients who had undergone face lift surgery warns that MRSA–positive surgical site infection "is an increasingly problematic issue in all surgical fields," and MRSA-positive infections "will be more prevalent and will require well-developed screening, prevention, and treatment strategies" in the future. The authors, Dr. Richard A. Zoumalan and Dr. David B. Rosenberg of the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Lennox Hill–Manhattan Eye, Ear, and Throat Hospital, said they believe theirs is the first study documenting MRSA-positive surgical site infections after face lift surgery.

Their results were published in the March-April 2008 issue of Archives of Facial Plastic Surgery (http://archfaci.ama-assn.org/cgi/content/full/10/2/116).

They examined the charts of 780 patients who had undergone a deep-plane rhytidectomy between 2001 and 2007, searching for postoperative wound infections. They identified five patients, four of whom had MRSA-positive infections that were treated successfully, but the two complicated infections that required hospitalization were the only ones among the five patients who had known recent contacts with another physician or a hospital, according to the paper.

MRSA is now the leading causative pathogen in surgical site infections. as well as in skin and soft tissue infections, Zoumalan and Rosenberg wrote. "In various recent studies involving patients who underwent vascular surgery, cardiac surgery, and orthopedic surgery, MRSA was the most common pathogen of surgical site infections. In most of the country, skin and soft tissue infections are now more likely to be MRSA positive. In Los Angeles County, [community acquired]-MRSA infections have rapidly become common and now exceed the frequency of infections caused by methicillin-sensitive Staphyloccocus aureus (MSSA)." Infections caused by MRSA cost approximately $3,700 more to treat than infections caused by MSSA, and the death rate for MRSA infection is nearly three times that of MSSA infection, according to their paper.

They also wrote that, while health care–associated MRSA is considered to be distinct from CA-MSRA, CA-MRSA recently entered the hospital setting, where it coexists with HA-MRSA; patients can acquire both strains from the hospital.

The recommend taking "every appropriate step" to prevent wound infections in facial plastic surgery, including chlorhexidine gluconate preoperative scrubbing and proper cleansing of a surgeon's hands between contacts with different patients.

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