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Impact of Methicillin-Resistant Staphylococcus aureus Prevalence among S. aureus Isolates on Surgical Site Infection Risk after Coronary Artery Bypass Surgery

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Loren G. Miller ,
James A. McKinnell ,
Michael E. Vollmer  and
Brad Spellberg
Loren G. Miller*
Affiliation:
Infectious Diseases Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California David Geffen School of Medicine at the University of California, Los Angeles, California
James A. McKinnell
Affiliation:
Infectious Diseases Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California
Michael E. Vollmer
Affiliation:
Infectious Diseases Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California
Brad Spellberg
Affiliation:
David Geffen School of Medicine at the University of California, Los Angeles, California Division of General Internal Medicine, Harbor-UCLA Medical Center, Los Angeles, California
*
Division of Infectious Diseases, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 466, Torrance, CA 90509 (lgmiller@ucla.edu)
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Abstract

Objective.

Cephalosporins are recommended for antibiotic prophylaxis to prevent cardiothoracic surgical site infections (SSIs) except in patients with β-lactam allergy or in settings with a “high” prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among S. aureus isolates (hereafter, “MRSA prevalence”); however, “high” remains undefined. We sought to identify the MRSA prevalence at which glycopeptide prophylaxis would minimize SSIs relative to β-lactam prophylaxis.

Methods.

We developed a decision analysis model to estimate SSI likelihood when either glycopeptides or β-lactams were used for prophylaxis in cardiothoracic surgery. Event probabilities were derived from a systematic literature review. A similar cost-minimization model was also developed.

Results.

At 0% MRSA prevalence, SSI probability was 3.64% with glycopeptide prophylaxis and 3.49% with β-lactam prophylaxis. At MRSA prevalences of 10%, 20%, 30%, or 40%, SSI probabilities with glycopeptide prophylaxis did not change, but they were 3.98%, 4.48%, 4.97%, and 5.47% with β-lactam prophylaxis. The threshold of MRSA prevalence at which glycopeptide prophylaxis minimized SSI probability and cost was 3%. In sensitivity analyses, variations in most model estimates only modestly affected the threshold.

Conclusion.

Glycopeptide prophylaxis minimizes the risk of SSIs and cost when MRSA prevalence exceeds 3%. At very low MRSA prevalence (between 3% and 10%), the SSI minimization provided by glycopeptide prophylaxis is small and may be within the error of the model. Given the current MRSA prevalence in most community and healthcare settings, clinicians should consider routine prophylaxis with vancomycin. Our findings may have important policy implications, as benefits in cardiothoracic surgery antibiotic prophylaxis must be weighed against the limitations of increased glycopeptide use.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 4 , April 2011 , pp. 342 - 350
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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