A prospective audit of complex wound and graft infections in Great Britain and Ireland: The emergence of MRSA

Background: a number of studies have examined the outcome of complex wound and graft infections, but most include small numbers of patients collected over a prolonged period of time. Tr, elate, there is little information on the clinical outcome of infections involving methicillin-resistant Staphylococcus aureus (MRSA). Methods: between February 1998 and January 1999, two prospective multi-centre audits were performed in order to examine the current outcomes following (1) complex vascular wound infections and (2) graft infections in Britain and Ireland with particular reference to outcome associated with MRSA infection. Results: seventy-five complex wound infections (Szylagyi II and III) were reported, with the commonest single organism being MRSA. Type II infections were associated with a 5% risk of death and/or amputation as opposed to 75% in those with a type III infection. Fifty-five graft infections were reported, with the commonest single organism being MRSA. Overall, 30 (55%) died or underwent amputation. MRSA wound and graft infections were associated with a significantly higher risk of amputation and prolonged hospital slay (but not of death) as compared with MRSA negative patients. Conclusions: in this audit, MRSA was the commonest single organism cultured in patients with complex wound and graft infections after vascular surgery. This represents a major change in the spectrum of causative organisms relative to other, older published series. MRSA infections contribute towards an increased risk of adverse outcome and prolonged hospital stay.