To identify the methicillin-resistant Staphylococcus aureus
) carrier rate among surgical patients on an orthopaedic trauma
service and to determine whether screening
is an effective tool for reducing postoperative MRSA
infection in this population.
Level 1 trauma center.
Two hundred forty-eight patients with operatively managed orthopaedic trauma
conditions during the study period. Two hundred three patients (82%) had acute orthopaedic trauma
injuries. Forty-five patients (18%) underwent surgery for a nonacute orthopaedic trauma
condition, including 36 elective procedures and 9 procedures to address infection.
Intervention: MRSA screening
protocol, preoperative antibiotics per protocol.
Main Outcome Measurements: MRSA
carrier rate, overall infection rate, MRSA
captured 71% (175/248) of operatively treated orthopaedic trauma
patients during the study period. The overall MRSA
carrier rate was 3.4% (6/175). When separated by group, the acute orthopaedic trauma
cohort had an MRSA
carrier rate of 1.4% (2/143), and neither MRSA
-positive patient developed a surgical site infection. Only one MRSA
infection occurred in the acute orthopaedic trauma
cohort. The nonacute group had a significantly higher MRSA
carrier rate of 12.5% (4/32, P
= 0.01), and the elective group had the highest MRSA
carrier rate of 15.4% (4/26, P
< 0.01). The odds ratio of MRSA
colonization was 10.1 in the nonacute group (95% confidence interval, 1.87–75.2) and 12.8 for true elective group (95% confidence interval, 2.36–96.5) when compared with the acute orthopaedic trauma
There was a low MRSA
colonization rate (1.4%) among patients presenting to our institution for acute fracture
care. Patients undergoing elective surgery for fracture
-related conditions such as nonunion, malunion, revision surgery, or implant removal have a significantly higher MRSA
carrier rate (15.4%) and therefore may benefit from MRSA screening
. Our results do not support routine vancomycin administration for orthopaedic trauma
patients whose MRSA
status is not known at the time of surgery.
Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.