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ICAAC: Presurgical Vancomycin May Have Limited Use Against MRSA

Using vancomycin before surgery appears to help reduce the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection in patients testing positive for colonization with nasal swabs -- but may not help patients without preoperative colonization, researchers said here.

A retrospective study analyzed nasal swabs taken from more than 4,000 patients in the Veterans Affairs (VA) Boston Healthcare System, using polymerase chain reaction to test for MRSA colonization, 31 days before surgery and found only 6.6% tested positive for the bacteria, Kalpana Gupta, MD, of the Boston University School of Medicine, reported at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

A second MRSA culture was taken 31 days after surgery. Among the 279 patients who initially tested positive, 33, or 12%, were found to have MRSA -- and 30 patients, or only 0.75%, of those who had tested negative had MRSA colonization post-surgery -- with an odds ratio of 17.6 (95% CI 10.2 to 30.1), she said.

Gupta concluded that pre-op MRSA nasal colonization was significantly associated with MRSA clinical cultures and surgical infections in the 31 day post-op period -- since the same number of patients (17) testing positive and negative before surgery developed MRSA infections postoperatively despite vancomycin prophylaxis.

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