MRSA and Ventral Hernia Repair: Look at Infection History

Americans undergo approximately 90,0000 ventral hernia repairs (VHR) annually. Those who contract methicillin-resistant staphylococcus aureus (MRSA) infections face a difficult course, and clinicians often struggle to eradicate this tenacious infection. An article in press in the Journal of the American College of Surgeons discusses exactly how difficult management is, and links MRSA infection in VHR patients to preoperative MRSA infection in any site.

This research team hails from Vanderbilt University Medical Center, Nashville, TN. They conducted a retrospective cohort study of patients (N=768 split approximately evenly between men and women) undergoing VHR with class I-III wounds from 2005-2012. They extracted all data from Vanderbilt University Medical Center’s Perioperative Data Warehouse. The factors of most importance to them included history of preoperative MRSA infection and surgical site infection (SSI) at 30 days.

Fifty-four (7%) of the 768 patients had been infected with MRSA before their VHR. Of these, 15 (28%) were soft tissue infection, 9 (17%) were bloodstream infections, 4 (7%) were pulmonary infections, 3 (6%) were urinary infections and 5 (9%) occurred in various other sites.

Eighty VHR patients developed an SSI. Patients who had had a previous MRSA infection were more likely to develop a VHR MRSA infection, with 33% of them developing new MRSA infections compared to 9% of those with no MRSA history.

Patients with previous MRSA infection were 2.3 times more likely than controls to have SSI 30-day after VHR. These patients were much more likely to have they have longer lengths of hospital stay compared to controls.

Myofascial release, higher BMI, longer operation duration, open repair, and clean-contaminated wound classification also increased risk of MRSA.

New perioperative techniques are needed to prevent MRSA infections in these patients. Further study is needed to determine whether certain types of surgical materials and perioperative antibiotics are associated with lower odds of SSI in this patient population.