Keywords
Methicillin-resistant
young patients
Surgical site infections
How to Cite
Abstract
Introduction: Surgical site infections (SSIs) pose a global health concern. While various pathogenic microorganisms can cause SSIs, a predominant causative agent is Staphylococcus aureus, particularly its methicillin-resistant strain (MRSA). MRSA, known for its resistance to multiple antibiotics, significantly complicates treatment options, leading to increased morbidity. In some cases, particularly among patients with pre-existing comorbidities, MRSA infections can prove fatal. Moreover, eradicating MRSA from hospital settings presents a formidable challenge.
This study aims to report on two young, otherwise healthy patients who developed MRSA infections in their surgical wounds during hospitalization.
Case Descriptions: A 22-year-old female patient developed an MRSA infection following an appendectomy and a 12-year-old male patient exhibited similar complications post-orchiopexy. In both cases, MRSA presence was confirmed through microbiological cultures a few days post-surgery. Repeated cultures indicated successful MRSA eradication after isolation and initiation of targeted antibiotic therapy based on antibiograms. Once their general health stabilized, the patients were discharged and continued outpatient antibiotic treatment for a prescribed duration.
Conclusion: These cases emphasize that MRSA infections, typically associated with elderly patients or those with underlying health conditions, can also occur in younger, healthier individuals. Eradicating these infections remains a significant challenge for healthcare facilities encountering MRSA.
Keywords: Staphylococcus aureus, Methicillin-resistant, young patients, Surgical site infections.
References
National Institute of Health and Clinical Excellence. Surgical site infection. Prevention and treatment of surgical site infection. Clinical Guideline 74. Published October 2008. Accessed October 31, 2013 www.nice.org.uk/nicemedia/live/11743/42378/42378.pdf.
World Health Organization. WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. http://whqlibdoc.who.int/publications/2009/9789241598552_eng. Pdf. It was accessed on October 31, 2013.
Tsubakishita S, Kuwahara-Arai K, Sasaki T, et al. Origin and molecular evolution of the determinant of methicillin resistance in Staphylococci. Antimicrob Agents Chemother. 2010; 54:4352-59.
Khan AU, Sultan A, Tyagi A, Zahoor S, Akram M, Kaur S. Amplification of mecA gene in multi-drug resistant staphylococcus aureus strains from hospital personnel. J Infect Dev Ctries. 2007; 1:289-95.
Borriello Peter S, Murray R. Patrick, Funke Guido in Topley & Wilson's Microbiology and Microbial Infections, Bacteriology; Hodder Arnold. 2007; 10th ed. 2: 793–4.
Iyamba JM, Wambale JM, Lukukula CM, zaBalegaTakaisi-Kikuni N. High prevalence of methicillin-resistant staphylococci strains isolated from surgical site infections in Kinshasa. Pan Afr Med J. 2014; 18:322.
Cole AM, Tahk S, Oren A, Yoshioka D, Kim YH, Park A, et al. Determinants of Staphylococcus aureus nasal carriage. Clin Diagn Lab Immunol. 2001;8(6):1064–69.
O’Hara LM, Thom KA, Preas MA. Update to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the prevention of surgical site infection (2017): A summary, review, and strategies for implementation. Am J Infect Control. 2018;46(6):602-609. doi:10.1016/j.ajic.2018.01.018
Surgical site infection event (SSI). National Healthcare Safety Network. Accessed April 26, 2022. https://www.cdc.gov/nhsn/pdfs/pscmanual/ 9pscssicurrent.pdf
Seidelman JL. Surgical site infection (SSI) trends in community hospitals from 2013 to 2018. Infect Control Hosp Epidemiol. Published online July 18, 2022. doi:10.1017/ice.2022.135
Negi V, Pal S, Juyal D, Sharma MK, Sharma N. Bacteriological profile of surgical site infections and their antibiogram: a study from the resource-constrained rural setting of Uttarakhand state, India. J Clin Diagn Res. 2015;9(10):17-20
Healthcare-associated infections FACT SHEET – WHO.
www.who.int/gpsc/ country work/gpsc_ccisc_fact_sheet_en.pdf
Ranjan KP, Ranjan N, Gandhi S. Surgical site infections with special reference to methicillin-resistant Staphylococcus aureus: experience from a tertiary care referral hospital in North India. Int J Res Med Sci. 2013;1(2):108-11.
Timothi FJ. The Staphylococcus aureus “superbug”. The Journal of Clinical Investigation. 2004; 114:1693-96
Anderson DJ, Arduino JM, Reed SD, et al. Variation in the type and frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical procedure. Infect Control Hosp Epidemiol. 2010;31(7):701-709. doi:10.1086/653205
Ranjan KP, Ranjan N, Gandhi S. Surgical site infections with particular reference to methicillin-resistant Staphylococcus aureus: experience from a tertiary care referral hospital in North India. Int J Res Med Sci. 2013;1(2):108–11.
Anderson DJ, Arduino JM, Reed SD, et al. Variation in the type and frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical procedure. Infect Control Hosp Epidemiol. 2010;31(7):701-709. doi:10.1086/653205
Krishna S, Divya P, Shafiyabi S. Postoperative surgical wound infections with special reference to methicillin-resistant Staphylococcus aureus: an experience from VIMS hospital, Ballari. J Biosci Tech. 2015;6(3):697-702
A. Khan, B. Wilson & I. M. Gould (2018) Current and future treatment options for community-associated MRSA infection, Expert Opinion on Pharmacotherapy, 19:5, 457–470, DOI: 10.1080/14656566.2018.1442826
Gould FK, Brindle R, Chadwick PR et al. Guidelines (2008) for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the United Kingdom. J Antimicrob Chemother 2009; 63: 849–61
Davis J, Sud A, O’Sullivan MVN, et al. Combination of Vancomycin and bLactam Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: A Pilot Multicenter Randomized Controlled Trial. Clin Infect Dis 2016; 62: 173–80.
Davis JS, Van Hal S, Tong SY. Combination antibiotic treatment of severe methicillin-resistant Staphylococcus aureus infections. Semin Respir Crit Care Med 2015; 36: 3–16.
Paul M, Bishara J, Yahav D et al. Trimethoprim-sulfamethoxazole versus Vancomycin for severe infections caused by methicillin-resistant Staphylococcus aureus: randomized controlled trial. Bmj 2015; 350: h2219
Kotagal M, Symons RG, Hirsch IB, et al.; SCOAP-CERTAIN Collaborative. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg. 2015; 261(1):97-103
Korol E, Johnston K, Waser N, et al. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS One. 2013;8(12): e83743
Berard F, Gandon J. Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and various other factors. Ann Surg. 1964;160(suppl 2):1-192
Rohde JM, Dimcheff DE, Blumberg N, et al. Health care–associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA. 2014;311(13):1317-1326
Edmiston CE Jr, Seabrook GR, Cambria RA, et al. Molecular epidemiology of microbial contamination in the operating room environment: Is there a risk for infection? Surgery. 2005;138(4): 573-579
Yuan K, Chen HL. Obesity and surgical site infections risk in orthopedics: a meta-analysis. Int J Surg. 2013;11(5):383-388
Grober ED, Domes T, Fanipour M, Copp JE. Preoperative hair removal on the male genitalia: clippers vs razors. J Sex Med. 2013;10(2):589-594. doi:10.1111/j.1743-6109.2012.02904.x
Rennert-May E, Conly J, Smith S, et al. A cost-effectiveness analysis of mupirocin and chlorhexidine gluconate for Staphylococcus aureus decolonization before hip and knee arthroplasty in Alberta, Canada, compared to standard of care. Antimicrob Resist Infect Control. 2019;8:113
Chen S, Chen JW, Guo B, Xu CC. Preoperative antisepsis with chlorhexidine versus povidone-iodine for preventing surgical site infection: a systematic review and meta-analysis. World J Surg. 2020;44(5):1412-1424.
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