MRSA colonisation in patients with proximal femur fractures in a German trauma centre: incidence, infection rates and outcomes

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The aim of this study was to assess the incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonisation in patients admitted into a level 1 German trauma centre with proximal femur fractures, to correlate this incidence with defined risk factors for MRSA colonisation and to determine its influence on morbidity and mortality. Between August and November 2006, 65 patients were included in the study. Cotton-tipped swab samples were taken from the nose, throat, groin and any skin defects in the emergency room. The following factors were recorded: age, gender, any concomitant diseases, the fracture type and treatment device, skin lesions, hospitalisation within the last year, any urinary or vascular catheters, a nasogastric or gastrostomy tube, an ileal stoma, the use of a respirator and antibiotic therapy within the last year. During follow-up, data concerning any surgical site infections; any chest, urinary or vascular catheter infections; the success of decontamination and death within 1year after surgery were collected. The risk factors for MRSA colonisation were positive in 40 patients. The incidence of MRSA colonisation was 17%, which is higher than in most comparable studies but consistent with some very recent publications. The nosocomial infection rates, surgical site infection rates and mortality within the 1-year follow-up period were significantly higher in the MRSA-colonised patients. The high incidence of MRSA in this study supports the need for systematic detection of MRSA-colonised patients. In our hospital, any patient with positive risk factors for MRSA colonisation is swabbed in the emergency room and treated as MRSA positive until proven otherwise.