To describe the prevalence and incidence of Methicillin-resistant Staphylococcus aureus (MRSA) colonisation during the patient journey for patients admitted to orthopaedic and trauma wards, we carried out a prospective audit at the University Hospital of North Staffordshire NHS Trust, England.

The Study Population comprised patients admitted to the trauma and elective orthopaedic wards, with an expected stay of 48 hours or more between March and May 2003.

Patients were swabbed for MRSA colonisation on ward admission, transfer to another ward and discharge from hospital. Elective patients undergoing major joint surgery were also swabbed at a pre-operative assessment clinic. Colonised patients were treated depending on individual risk assessment.

Five hundred and fifty-nine eligible patients were admitted to hospital. Of these, 323 (101 elective, 192 trauma and 30 non-orthopaedic) patients were included in the study, of whom 28 elective patients (28%), 43 trauma patients (22%), and seven non-orthopaedic patients (23%) were colonised with MRSA at any time during the audit period. Of the 80 patients identified as negative for MRSA colonisation at pre-assessment screening and included in the audit, ten (9.5%) were found to be colonised on admission.

There is a high prevalence of MRSA colonisation in patients admitted to the orthopaedic and trauma wards in our setting. A policy of pre-admission screening, though able to identify MRSA carriage does not guarantee that patients are not colonised in the period between screening and admission. Consideration should be given to screening all patients for MRSA who are admitted to an orthopaedic ward.

Antibiotic-associated Clostridium difficile diarrhoea may complicate surgery for proximal femoral fracture. We undertook a 4 year case control study to evaluate the effects of a change in antibiotic prophylaxis in our department.

In the period January 2003 to January 2005, patients received three doses of cefuroxime (1.5 g). The new regimen is a single dose of cefuroxime (1.5 g) with gentamicin (240 mg) at induction. Prior to the change in prophylaxis, 912 patients underwent surgery for neck of femur fracture. Following the change, 899 patients underwent surgery over the period March 2005 to March 2007. 38 patients developed C. difficile infection (4.2%) in the initial group, compared with 14 patients (1.6%) in the group following the change in prophylaxis (P=0.009). Patients with C difficile infection also had a statistically significant increase in antibiotic exposure, inpatient stay, morbidity and inpatient mortality.

The main challenges regarding antibiotic selection are failure of prophylaxis, often because of infection with MRSA, and C. difficile-associated diarrhoea as a consequence of antibiotic prophylaxis. Infection with C. difficile is reduced with the new regimen. We advocate the use of the new regimen as an effective alternative to multiple dose cephalosporins for the prevention of C. difficile infection in this group of high risk patients.

Introduction: Antibiotic-associated Clostridium difficile diarrhoea may complicate surgery for proximal femoral fracture. We sought to determine whether a change in antibiotic policy in our unit influenced rates of infection with C. difficile following hip fracture surgery.

Methods: A 4 year case controlled study. A change in antibiotic prophylaxis was introduced during a 3 month period in 2005. Infection rates with C. difficile were compared for 2 years either side of this period. The initial regimen was one of three doses of cefuroxime (1.5 g). The new regimen is a single dose of cefuroxime (1.5 g) with gentamicin (240 mg) at induction. Infection was defined as diarrhoea with a positive isolate within 30 days of surgery.

Results: Prior to the change in prophylaxis, 912 patients underwent surgery for neck of femur fracture. Following the change, 899 patients underwent surgery over the period March 2005 to March 2007. 38 patients developed C. difficile infection (4.2%) in the initial group, compared with 14 patients (1.6%) in the group following the change in prophylaxis (P=0.009). Patients with C difficile infection also had a statistically significant increase in antibiotic exposure, inpatient stay, morbidity and inpatient mortality.

Discussion: The main challenges regarding antibiotic selection are failure of prophylaxis, often because of infection with MRSA, and C. difficile-associated diarrhoea as a consequence of antibiotic prophylaxis. Infection with C. difficile is reduced with the new regimen. We advocate the use of the new regimen as an effective alternative to multiple dose cephalosporins for the prevention of C. difficile infection in this group of high risk patients.

Objective: To describe the prevalence and incidence of methicillin resistant Staphylococcus aureus (MRSA) colonisation in patients in the Trauma and Orthopaedic wards of the University Hospital of North Staffordshire.

Design Prospective audit.

Patients and methods: Over a three month period from 1st March to 31st May 2003 359 patients attending the elective orthopaedic outpatient department for major joint surgery were screened at the pre-operative assessment clinic; 105 of these patients were screened again on the elective orthopaedic wards. 197 patients were screened on the trauma wards. 31 patients of other/outlying specialities were screened. Patients whose stay was expected to be for 48 hours or more were included in the audit. Patients were screened for MRSA colonization on admission, transfer and discharge. Colonised patients were treated according to the local infection control policy.

Results: 31 elective orthopaedic patients (29%); 46 trauma patients (23%) and 8 other/outlying patients (26%) were colonized with MRSA. On admission, 23 elective orthopaedic patients (22%), 32 trauma patients (16%), and 7 patients (23%) which were of other/outlying specialties were colonized with MRSA. 22 patients (6.6%) positive on admission, treated with eradication therapy, became negative on discharge. An additional 22 patients (6.6%) positive on admission became negative on discharge without receiving any treatment. During the audit period, 23 patients (6.9%) were negative for MRSA on admission and positive on discharge. 9 patients (39%) and 20 patients (62.5%) colonised in elective and trauma wards respectively, developed an MRSA infection, which required treatment.

Conclusion: There is a relatively high prevalence of MRSA colonisation in patients admitted to orthopaedic and trauma wards. A proportion (22%) of patients are colonised with MRSA in the short time between testing and admission. Not all patients positive for MRSA following admission to hospital will have been colonised within the nosocomial environment.