Nosocomial MRSA Infections, Annotated Bibliography Example

Ahmed, Mohamed Issa. Prevalence of nosocomial wound infection among postoperative patients and antibiotics patterns at teaching hospital in Sudan. North American Journal of Medical Science. January 2012; 4(1): 29–34.

The study was conducted in Gadarif State Hospital in eastern Sudan. 109 would swabs were collected from post-operative patients; of those swabs, 55% were found to display contamination by MRSA, with another 29% showing contamination from a range of other pathogens. In 2011, 25.3% of post-operative patients became septic, with a majority of the infections caused by MRSA.

In addition to offering the statistical information about the prevalence of MRSA and other pathogens in Gadarif State Hospital, the author of the study devotes considerable space to a general discussion of nosocomial infections in Gadarif and in other hospital regions.

Examination is given over to the various ways in which patients can become infected by MRSA and other pathogens. According to the study, it can be difficult to determine the difference between a wound that is actually infected and one that is simply contaminated wit or colonized by bacteria. In many cases, a wound might become contaminated by pathogens found in the clinical environment, though this contamiantio does not necessarily mean that the wound is infected. The amount of contamination may sometimes be low, and the number of pathogens found in the wound will not necessarily grown in number or establish themselves to the degree that infection sets in.

In the case of infection, the body’s defenses become unable to fight off the deleopment nand multiplication of the pathogens in the wound site; at this stage, the colomizing bacteria begin to multiply rapidly, feeding off the living tissue in the wound. It is this set of conditions that qualifies as infection, and such cases are typically treated with various antibiotics. Even with such treatment, the tissue at the site of the wound can become completely broken down by the infection, and it can be difficult or even impossible to treat the infection with standard methods.

This is, of course, the problem most commonly associated with MRSA-type nosocomial infections. Conventional antibiotics, when applied to the infection, prove to be ineffective, as the bacteria are resistant to them. There are particularly powerful antibiotics that can be effective for the treatment of MRSA, though it is not always possible to alleviate infections even with the string antibiotics. The study explains that MRSA and other drug-resistant pathogens have developed such resistance in large part because of the over-prescribing and over-use of antibiotics, and the use of ever-stronger antibiotics may also lead to the development of ever-more-resistant bacteria.

Along with antibiotic treatments, MRSA skin infections, such as those most typically associated with post-operative wound infections, are also often treated with incision and drainage in an effort to remove as much of the infected tissue as possible. Generally speaking, the treatment of severe MRSA-related infections requires some combination of both drug therapies and the application of incision and drainage, all in an effort to minimize the damage caused by the infection and to support the body’s efforts to fight off the bacteria and to heal the wound.

MRSA is particularly difficult to treat, as it is found throughout many clinical settings; environmental samples from Gadarif show that MRSA and other pathogens flourish throughout the facility due to improper and ineffective decontamination and sterilization procedures. Because the region is economically depressed, it is often difficult to acquire the needed supplies and medications to combat nosocomial infections in Gadarif State Hospital and other medical facilities in the Sudan, and the author urges international governments and non-governmental organizations to offer much-needed assistance in combating the spread of MRSA.

Fierobe, Lisiane et al. Methicillin-resistant staphylococcus aureusas a causative agent of postoperative intra-abdominal infection: relation to nasal colonization. Clinical Infectious Diseases. 1999; 29(5): 1231-1238.

This study was conducted at the Bichat University Hospital in Paris, France. The study was conducted among patients in the surgical ICU of the hospital, and focused on post-operative intra-abdominal infections. Nasal swabs of 73 patients who developed post-operative intra-abdominal infections were examined over a 17-month period. 23% of the PIAIs in the study group were demonstrated to have been caused by MRSA.

Along with the specific information about MRSA, the study offers a general overview of MRSA and non-MRSA related nosocomial infections, and discusses the various complications and concomitant conditions that can arise in post-op infectious situations. The authors stress the importance of combating the spread of MRSA with pro-active measures, such s increasing and strengthening protocols for disinfection and decontamination of the hospital environment.

Hussain, Shagufta et al. Prevalence of methicillin resistant staphylococcus aureus (MRSA) in surgical site infections in a tertiary care hospital. International Journal of Pathology; 2005; 3(2): 81-85.

This study was carried out under the auspices of the Department of Pathology and Surgery at the Pakistan Institute of Medical Sciences in Islamabad, Pakistan. The focus of the study was on the surgical wards and surgical ICU of the facility, and was designed to determine the prevalence of MRSA as a cause of post-operative infections in patients at the hospital.

The study is unclear as to how many patients were actually swabbed for detection of pathogens, but it does indicate that 1373 swabs developed growth of bacterial pathogens. Of those that displayed such growth, 273 (20%) of them were positive for MRSA. Patients in the surgical ICU were 35% more likely to demonstrate the development of MRSA and other pathogens in their samples than were patient in the standard surgical ward. According to the study, “it is concluded that MRSA is a serious nosocomial pathogen in surgical site infections and requires strict intervention for its prevention and control.”

Kateete, David P. et al. High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda. BMC Research Notes. 2011. 4(326).

The researchers note that the spread of MRSA is rapidly becoming a global epidemic, and is affecting industrialized countries, where antibiotics have been commonly used for decades, at an alarming rate. Further, note the authors, it is often difficult to correctly assess the prevalence of MRSA in developing nations, as the expense involved in using chromogen agar for detection is prohibitively high.

The study took place in two surgical units in Kampala, Uganda; these units specialized in surgical treatments for burn victims. The researchers took samples from 25 post-operative patients, from 36 health-care workers (HCWs), and from 39 environmental sources. 41 positive results were found; 13 came from post-op patients, 13 came from HCWs, and 15 came from environmental sources. This outcome amounted to a 40% rate of positive tests for MRSA, clearly demonstrating the significance of the situation. Overall, roughly 10% of post-op patients in these units become septic with MRSA being the most prevalent source of infection.

Taylor, MD; Napolitano, LM. Methicillin-resistant Staphylococcus aureus infections in vascular surgery: increasing prevalence. Surgical Infection. Summer 2004; 5(2):180-7.

The study was conducted at the vascular surgical center at the University of Maryland Hospital in Baltimore, MD. All patients who developed post-operative complications were included in the study; 119 patients were identified as having developed post-op complications during the study period. Of those 119 patients, 79 (66.4%) developed Hospital-acquired infections (HAIs). 60.8% of the nosocomial infections in these patients that developed post-op HAIs were caused by MRSA; the majority of those nosocomial infections were determined to have originated at the surgical site. The researchers concluded that MRSA was the most significant cause of post-op infections in the hospital, and further determined that the statistical evidence showed that the rate of MRSA infections was growing rapidly.