MRSA Colonisation And Infection In Neurosurgical Patients;Clinical Case Analysis

Objective:Methicillin Resistant Staphylococcus Aureus(MRSA)is a major cause of neurosurgical infections worldwide.It can cause numerous infections such as Ventilator Associated Pneumonia,Ventilator Associated Tracheobronchitis,Pneumonia,Surgical Site Infections,Meningitis/Ventriculitis and Blood Stream Infections.It can be highly devastating and the mortality rates can be very high.There are several risk factors associated with MRSA infections.During the recent decade there has been a decrease of MRSA infections incidence around the world reported by different authors.This study is set up to investigate the incidence of MRSA positive patients including colonisation and infection patients and their respective trends in the Neurosurgical Department of The First Affiliated Hospital Of Zhejiang University,School Of Medicine.Methods:A retrospective analysis of our Neurosurgical patients with MRSA positive specimens in the last half decade was conducted from January 2013 and December 2017.The patients were classified as MRSA Colonisation and MRSA infections.Infections were further divided into MRSA VAT/VAP,MRSA Pneumonia and Others which included MRSA BSI,MRSA SSI,MRSA Meningitis.All the diagnosis were made according to the CDC guidelines.Ratio of MRSA-infection and colonisation per 1000 admissions per year were calculated and trends were analysed.Results:94 patients were MRSA positive accounting for 103 cases with the aid of 104 specimens mainly from the sputum.Pneumonia(50 cases)and VAT/VAP(27 cases)were the most common infections.Vancomycin was the most common antibiotics used prior to surgery,after surgery and before detection of MRSA.There were 25(25.5%)non surgical patients and 70(74.5%)surgical patients.Decompressive craniotomy and hemorrhagic stroke were the most common surgical procedures among the surgical patients.46(48.9%)patients underwent multiple procedures.26(27.7%)patients were admitted to the ICU prior to being MRSA positive which was statistically significant.There were 5 cases of mixed infections in this study.There was a significant decline in the incidence of MRSA patients in our hospital during the study period.This was a fact for Colonisation patients as well as for MRSA Pneumonia,MRSA VAT/VAP,MRSA BSI,MRSA SSI and MRSA Meningitis patients.Conclusion:There has been a marked declination in MRSA positive(colonisation and infection)patients in the past 5 years.This is suggestive of a good bundle base approach care and strict infection control protocol.Our bundle base approach has favour the declination of several types of MRSA infection in the Neurosurgical Department.