Methicillin-resistant Staphylococcus aureus incidence and outcome in patients with neck of femur fractures

Since the 1980s, methicillin-resistant Staphylococcus aureus (MRSA) has been identified as a significant infectious agent with an increasing incidence within both hospitals and the community. The aim of this study was to measure the incidence of MRSA colonization in patients admitted with a neck of femur fracture requiring implant surgery and to assess the outcome of these cases. We also sought to identify any risk factors associated with MRSA colonization, and to assess the need for any prophylactic treatment to prevent postoperative MRSA infection. Nasal, perineal and (where present) wound site swabs were taken on a sequential series of patients admitted with a neck of femur fracture who required a surgical implant. The presence of MRSA isolates from these swabs and the presence of a significant postoperative infection in both the colonized and non-colonized patients were recorded. A total of 66 patients were enrolled in the study, of whom 63 had surgical treatment for their fracture. A total of four patients were found to be colonized with MRSA. Of the study group, 27 patients had been admitted to hospital in the Previous year, three of whom were found to be colonized with MRSA. Four of the patients were noted to have a postoperative infection-all of these cases were in the non-colonized group. The incidence of MRSA colonized patients in this series was 6%-a figure broadly consistent with previous studies. This does not appear to justify the routine screening of all neck of femur fracture admissions, though the results do suggest that a selective policy of screening only those who patients who had been admitted to hospital within the last year may be profitable. Our study does not appear to show any correlation between MRSA colonization and postoperative infection however. This is consistent with previous studies and does not support the adoption of an aggressive strategy for detection or eradication of MRSA prior to neck of femur fracture surgery. (C) 2002 The Hospital Infection Society.