Methicillin resistant Staphylococcus aureus in patients undergoing major amputation

Objectives: to examine the impact of MRSA infection on patients undergoing major amputation. Setting: District General Hospital. Methods: patients having had major amputation and positive MRSA cultures January 1995-December 1999 were included. Outcome was compared with a randomly chosen group of patients having major amputation but no positive MRSA culture from the same time period. Results: overall 27% of patients undergoing amputation were MRSA positive. Some 28 patients (30 amputations) with MRSA positive cultures were compared with 44 patients (54 amputations) who did not have positive cultures for MRSA. MRSA was isolated from the wound in 17 of 30 amputations. More patients in the control group had a below knee amputation (38 of 54 compared with 12 of 30, p <0.02). Mortality in MRSA positive patients was higher than controls, (12 of 28, 43%, versus 4 of 44, 9%, p <0.01). Primary healing was achieved in only 4 of 17 (24%) amputations where MRSA was isolated from the wound, This compared with 31 of 54 (57%) controls (p <0.05). Delayed healing due to chronic infection was also more likely in MRSA positive patients (p <0.01). Conclusion: in view of the high morbidity and mortality in patients with MRSA positive isolates specific antibiotic prophylaxis against MRSA should be considered in patients undergoing major amputation.