RT Journal
A1 Walsh EE, Greene L, Kirshner R
T1 SUstained reduction in methicillin-resistant staphylococcus aureus wound infections after cardiothoracic surgery
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2010
FD September 13
VO 171
IS 1
SP 68
OP 73
DO 10.1001/archinternmed.2010.326
UL http://dx.doi.org/10.1001/archinternmed.2010.326
AB 
Surgical site infections (SSIs) after cardiothoracic (CT) surgery carry significant morbidity and mortality as well as substantial monetary costs.1- 2 Although the overall incidence of serious deep sternal or mediastinal wound infections is relatively low, ranging from 0.5% to 3%, prolonged hospitalization or readmission for extensive surgical debridement of the chest followed by lengthy antibiotic therapy is often required. Staphylococcus aureus is implicated in approximately half of these infections, with coagulase-negative staphylococci, gram-negative bacilli, and yeast organisms less frequently responsible.3- 4 During the past 2 decades, the proportion of SSIs due to methicillin-resistant Staphylococcus aureus (MRSA) after cardiac surgery has steadily increased at many institutions.5 In contrast to many other pathogens, antibiotic therapy for MRSA is suboptimal and, even when combined with surgical debridement treatment, failure is not uncommon.6 Therefore, some institutions have developed strategies directed at preventing staphylococcal surgical wound infections, and specifically MRSA infections, after cardiac surgery.7- 20 Because it has generally been assumed that SSIs are caused by patients' endogenous flora, most control measures have focused on preoperative identification of MRSA carriers, with subsequent isolation, decolonization with intranasal mupirocin calcium ointment, and intravenous vancomycin for prophylaxis.8,10,17,19 The success of these efforts has been variable, although placebo- and historically controlled intervention studies have reported reductions of 37% to 90% in S aureus SSIs, including those due to MRSA.