Methicillin-resistant Staphylococcus aureus infection in vascular surgicalpatients

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infection is emerging as a major problem in vascular surgical practice. The aim of this study was to review the management of patients with MRSA infection complic ating vascular surgical operations. Methods: Data were obtained from the vascular audit, case notes, intensive therapy unit (ITU) notes, high dependency unit (HDU) notes and microbiologi cal records of patients who underwent either arterial reconstruction (n = 4 64) or limb amputation (n = 110) between April 1994 and October 1998. Results: Forty-nine vascular surgical patients developed clinical MRSA infe ction (9%). Clinical MRSA infection in patients who had undergone aorto-ili ac reconstruction (n = 18) was associated with a 56% mortality (n = 10) and the most common infections were bacteraemia (55%) and pneumonia (50%). MRS A infection occurred in 17 patients who had undergone infra-inguinal bypass and was associated with a 29% mortality (n = 5). The most common site of M RSA infection was the groin wound (76%) leading to anastomotic dehiscence a nd death in one patient (11%) and necessitating wound debridement in 4 pati ents (22%). MRSA infection of the groin wound in the presence of a prosthet ic graft (n = 3) led to anastomotic dehiscence in 2 patients, and graft exc ision in 2 patients. Similar complications were not observed in the presenc e of an underlying autogeneous long saphenous vein graft (n = 16). MRSA inf ection following major lower limb amputation (n = 14) was associated with d eath in 5 patients (36%). Wound infection in 10 amputees (71%) led to revis ion of the amputation to a higher level in 2 (14%) and wound debridement: i n 2 (14%). Conclusions: MRSA infection has a high mortality in vascular surgical patie nts in general, and following aorto-iliac reconstruction in particular. Aut ogeneous vein may confer some protection against local complications follow ing groin wound infection. Strategies aimed at reducing the incidence of in fection, including strict adherence to infection control procedures, may re duce the severity of this problem.