Community-acquired versus hospital-acquired methicillin-resistant Staphylococcus aureus in postoperative orthopaedic infections:  A prospective observational study.

Usha Rani   Vadlamanu; Sujatha Pambi; Chandrasekhar; Keshava Rao  Bolloju MS

doi:10.51168/sjhrafrica.v6i6.1919

Authors

Dr. Usha Rani Vadlamanu Associate Professor, Department of Microbiology, Government Medical College, Narsampet, Warangal District, Telangana, India 506132
Dr. Sujatha Pambi Associate Professor, Department of Community Medicine, Government Medical College, Narsampet, Warangal District, Telangana, India 506132
Dr. Chandrasekhar Associate Professor, Department of Orthopaedics, Government Medical College, Khammam, Telangana, India 507002
Dr. Keshava Rao Bolloju Associate Professor, Department of Orthopaedics, Government Medical College, Narsampet, Warangal District, Telangana, India 506132

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1919

Keywords:

Methicillin-resistant Staphylococcus aureus, Community-acquired, Hospital-acquired Methicillin-resistant Staphylococcus aureus, Orthopaedic infections, Surgical site infection, Antimicrobial resistance, Wound infection

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant cause of postoperative orthopaedic infections worldwide. Differentiating community-acquired MRSA (CA-MRSA) from hospital-acquired MRSA (HA-MRSA) is critical for effective treatment, infection control, and public health planning.

Objective: This study aimed to compare the prevalence, clinical profiles, antibiotic susceptibility patterns, and outcomes of CA-MRSA and HA-MRSA infections in postoperative orthopaedic surgical site infections (SSIs).

Methods: A prospective observational study was conducted over 18 months in a tertiary care teaching hospital. Patients developing SSIs within 30 days after orthopaedic surgery were included. Wound swabs and pus samples were processed for culture and sensitivity testing. MRSA was identified by cefoxitin disc diffusion and mecA gene PCR. Cases were classified as CA-MRSA or HA-MRSA per CDC criteria. Clinical data, risk factors, antibiotic susceptibility, and outcomes were analysed.

Results: Among 146 SSI cases, MRSA was isolated in 57 (39.0%), with 24 (42.1%) CA-MRSA and 33 (57.9%) HA-MRSA. HA-MRSA cases had higher rates of prior hospitalization (78.8% vs. 20.8%, p<0.001), previous antibiotic use (66.7% vs. 25.0%, p=0.002), and comorbidities. CA-MRSA isolates were more susceptible to clindamycin (87.5%) and trimethoprim-sulfamethoxazole (79.2%) compared to HA-MRSA (51.5% and 36.4%). All isolates were uniformly sensitive to vancomycin and linezolid. HA-MRSA infections were linked to longer wound healing and hospital stays (p=0.01).

Conclusion: Both CA-MRSA and HA-MRSA contribute considerably to postoperative orthopaedic infections. HA-MRSA is more common and associated with worse clinical outcomes. Variations in susceptibility patterns highlight the importance of targeted empirical therapy and strict infection control measures.

Recommendations: Implement routine MRSA typing, reinforce antibiotic stewardship, enhance preoperative screening, and strengthen hospital hygiene practices to reduce MRSA burden and improve patient outcomes.

Author Biographies

Dr. Usha Rani Vadlamanu , Associate Professor, Department of Microbiology, Government Medical College, Narsampet, Warangal District, Telangana, India 506132

Dr. Vadlamanu Usha Rani, MD, is an accomplished microbiologist with over 15 years of experience in diagnostic microbiology, antimicrobial resistance, and medical education. She earned her M.B.B.S. from Kakatiya Medical College, Warangal, where she was awarded University Distinctions in Pharmacology and Forensic Medicine. She subsequently completed her M.D. in Microbiology at Osmania Medical College, Hyderabad, ranking second in the NTR University final examinations. Dr. Usha Rani has held faculty positions at Kakatiya Medical College and currently serves as Associate Professor in the Department of Microbiology at Government Medical College, Narsampet. Her academic interests focus on infection control, antimicrobial stewardship, and the immunological diagnosis of infectious diseases. She has conducted pioneering research on doripenem susceptibility in Gram-negative bacilli and the early diagnosis of dengue infections using serological and molecular methods, for which she received the prestigious Bhaskaran Award. She has authored peer-reviewed publications in the Journal of Biomedical and Pharmaceutical Research, with her papers indexed in EMBASE, DOAJ, SCOPUS, and Index Copernicus. She has presented her work at numerous national conferences and contributed to advancing evidence-based practices in microbiology. In addition to her research contributions, Dr. Usha Rani has been actively involved in teaching undergraduate and postgraduate students and has delivered training on hospital epidemiology and PCR techniques. She is committed to improving laboratory practices and infection control protocols and continues to mentor young clinicians and microbiologists. Her ORCID is https://orcid.org/0009-0000-4865-0932.

Dr. Sujatha Pambi , Associate Professor, Department of Community Medicine, Government Medical College, Narsampet, Warangal District, Telangana, India 506132

Dr. Pambi Sujatha, MD (Community Medicine), is a committed medical educator and public health professional who completed her MBBS from Prathima Institute of Medical Sciences, Karimnagar, and pursued her postgraduate training (MD) in Community Medicine at Kakatiya Medical College, Warangal. She began her academic career as an Assistant Professor in the Department of Community Medicine at Kakatiya Medical College, Warangal, where she served from 2019 to 2024, actively engaging in undergraduate and postgraduate teaching, mentoring, and community health programs. Since 2024, she has been serving as an Associate Professor in Community Medicine at Government Medical College, Narsampet, where she continues to contribute to academic development and public health practice. Dr. Sujatha has authored numerous research publications in reputed peer-reviewed journals indexed in SCOPUS, DOAJ, and EMBASE, reflecting her commitment to advancing knowledge in epidemiology, maternal and child health, and non-communicable disease prevention. She has received awards in various sports and games competitions at institutional and intercollegiate levels, demonstrating her holistic approach to professional and personal growth. Known for her excellent teaching capabilities, she is highly regarded for delivering clear, engaging lectures and practical training sessions, effectively guiding undergraduate and postgraduate students in Community Medicine. Her ORCiD is https://orcid.org/0009-0002-1602-7809

Dr. Chandrasekhar , Associate Professor, Department of Orthopaedics, Government Medical College, Khammam, Telangana, India 507002

Dr. Chandrasekhar B.M., MS (Orthopaedics), is a highly accomplished orthopaedic surgeon with over 30 years of distinguished clinical experience and a steadfast commitment to medical education. He began his academic career as an Assistant Professor in the Department of Orthopaedics at Government Medical College, Suryapet, serving from 2019 to 2024, where he played a pivotal role in training undergraduate and postgraduate students and enhancing the department’s clinical standards. Since June 2024, he has been working as an Associate Professor at Government Medical College, Khammam, where he continues to mentor future orthopaedic surgeons with dedication and insight. Dr. Chandrasekhar is renowned for his exceptional surgical skills, encompassing complex trauma fixation, joint replacement, arthroscopic procedures, and deformity correction, all performed with meticulous precision and an evidence-based approach. He has authored several publications in reputed peer-reviewed journals, with many of his research articles indexed in leading international databases such as Scopus, EMBASE, and the Directory of Open Access Journals (DOAJ), reflecting the scientific rigor, credibility, and impact of his scholarly work in advancing the field of orthopaedics. Highly regarded for his clear, methodical teaching style and his ability to instill both confidence and competence in his trainees, Dr. Chandrasekhar embodies professionalism, integrity, and excellence in every facet of his clinical and academic endeavors.

Dr. Keshava Rao Bolloju, Associate Professor, Department of Orthopaedics, Government Medical College, Narsampet, Warangal District, Telangana, India 506132

Dr. Keshava Rao Bolloju, MS, is a distinguished orthopaedic surgeon currently serving as an Associate Professor in the Department of Orthopaedics at Government Medical College, Narsampet, Telangana. He also functions as a National External Assessor for the National Quality Assurance Standards (NQAS) Programme, contributing to the quality assessment and accreditation of government hospitals across India. Previously, he held the position of Assistant Professor at MGM Hospital and Kakatiya Medical College, Warangal, where he contributed extensively to both clinical services and academic mentorship. Dr. Bolloju earned his Bachelor of Medicine and Bachelor of Surgery (M.B.B.S.) from Kakatiya Medical College, Hanumakonda, Warangal (2000–2005), followed by a Master of Surgery (M.S.) in Orthopaedics from the Prathima Institute of Medical Sciences, Karimnagar, Telangana (2012–2015). With over a decade of dedicated service spanning primary, secondary, and tertiary healthcare settings, he has demonstrated exceptional proficiency as a treating physician, medical officer, and programme officer for national health initiatives throughout the erstwhile state of Andhra Pradesh and present-day Telangana. Renowned for his surgical acumen, Dr. Bolloju possesses advanced expertise in managing complex trauma, performing joint reconstructions, and employing Ilizarov’s technique of external fixation for limb salvage and correction of severe deformities. His surgical repertoire encompasses the management of polytrauma, open fractures, neglected injuries, and deformity corrections, delivered with a patient-centred approach that emphasises functional recovery and quality of life. He has been instrumental in training and mentoring undergraduate and postgraduate medical students, integrating evidence-based practices into orthopaedic education. His primary research interests include trauma care protocols, general orthopaedics, and innovations in external fixation techniques. Dr. Bolloju has organised numerous outreach health camps, delivering specialised care to individuals with disabilities and facilitating the issuance of disability certificates to support their social and economic empowerment. He has authored and co-authored multiple research publications in reputable indexed journals, including EMBASE, SCOPUS, and DOAJ, reflecting his sustained commitment to advancing orthopaedic science and improving patient care. His ORCID is https://orcid.org/0009-0007-9372-8955.

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