Implications of Methicillin-Resistant Staphylococcus aureus Carriage on Cardiac Surgical Outcomes

Abstract

Staphylococcus aureus remains the most common cause of sternal surgical site infections (SSIs). Opinions on the postoperative implications of preoperative methicillin-resistant S aureus (MRSA) colonization currently differ. This study aimed to investigate whether MRSA carriage affects postoperative outcomes and safety of operation. A total of 1,774,811 cardiac surgical patients from 2009 to 2014 were identified from the National Inpatient Sample database. Among these patients, 5798 (0.33%) were MRSA carriers. Propensity-score matching was used to determine the effect of MRSA colonization on outcomes. MRSA carriers did not differ in age or sex from noncarriers, but they more often presented for urgent surgery (P< .001). Among matched pairs, there was no difference in mortality (P= .76), stroke, SSIs, pneumonia, renal failure, cardiac complications, respiratory failure, or prolonged mechanical ventilation. MRSA infection (P < .001), MRSA septicemia (P= 0.03), and blood transfusion (P= .003) occurred more often among MRSA carriers. There was no increase in cost (P= .12), but the hospital length of stay was longer (P= .005). Predictors of MRSA infection among carriers included age older than 85 years, rural hospital location, and diabetes. Carriers with endocarditis and drug abuse were at highest risk for MRSA infection. MRSA carriers undergoing cardiac surgery are not at higher risk for mortality or SSIs and can expect outcomes similar to those of noncarriers. Higher rates of postoperative MRSA infection and septicemia among carriers, although still very low, support the need for selective preoperative screening and prophylaxis when possible.