Abstract
MRSA/MRSE infections appear to be increasing in prevalence and virulence. Prevalence has increased from 2.4% of all infected TJAs in 1975 to 37% in 2006.
In addition work from several centers has shown that cure rates for these infections are far below that of nonresistant organisms. In a recent study from our institution 50 consecutive cases of MRSA/MRSE were treated with two-stage exchange with a Prostalac spacer as the interval operation. Final reinfection rate was 18% which was far worse than the 4% failure reported from our center in MS staph species. This high failure rate is supported by work from other centers.
Clearly with the increasing prevalence and virulence of MRSA/MRSE new strategies are needed. The rest of this talk will focus on 2 different strategies: prevention and treatment.
Prevention strategies can either target carriers or all patients. In a study by Kim et al. carriers were targeted and they reported a 50% reduction in surgical site infections. At our institution a recent program was implemented where all surgical patients were targeted. Results from this will be presented.
While prevention strategies seem quite hopeful new treatment options have to be looked at. Traditionally vancomycin has been the mainstay of local and systemic treatment. Other options currently being explored include such agents as fusidic acid, daptomycin and liniazid. Research is looking at the effectiveness of these agents both locally and systemically.
MRSA/MRSE infections are becoming increasingly difficult to treat. New strategies for combatting these will include both new prevention and treatment strategies as outlined in this talk.
