Epidemiology of MROs in surgical prophylaxis: an analysis of organism, surgical procedures and requirements for alternative surgical antibiotic prophylaxis

Dr Stella  Son1, Ms Jan Roberts2, Dr Kathryn Daveson2

1Australian National University Medical School, Garran, Australia, 2The Canberra Hospital, Garran, Australia

Introduction: The number of patients undergoing surgical procedures with multi-resistant organisms (MRO) is increasing.  Guidelines on surgical antibiotic prophylaxis (SAP) deal poorly with alternative choices for MROs other than MRSA.  The epidemiology of MROs in surgery is not well described.

Methods: A 2-year retrospective clinical audit at a principal referral hospital was performed reviewing the epidemiology of patients undergoing surgical procedures with MRO alerts.  The need for alternative SAP was assessed against guidelines or where no guidelines were available, expert opinion.

Results: 177 patients over 2 years were identified with 304 surgical procedures. 49% (N=149) had known MRO alerts prior to the procedure. Orthopaedics (25%), general surgery (25%) and vascular surgery (17%) were the highest surgical groups with MRO alerts. MRSA was the most common alert (68%, 102/149), followed by VRE (23%, 34/149). The proportion assessed as requiring alternative prophylaxis due to the MRO alert was 72% (106/149) with only 14% (14/106) receiving it. The majority of alternative SAP recommendations were for MRSA (91%, 93/106), followed by multi-resistant Enterobacteriaceae (4%, 4/106).  A recommendation for a change in prophylaxis for VRE colonisation was uncommon.

Conclusion: The need for alternative SSP choices in patients with a known MRO may be high and is currently not being administered routinely. The burden of this requirement will likely increase in coming years with increasing rates of societal antimicrobial resistance.  How we deal with this issue as a multidisciplinary team, particularly where there are no guidelines available, needs addressing. An overview of this is suggested.


Kathryn Daveson is employed by both ACT and Queensland Health as a Staff Specialist in Infectious Diseases.  She is currently the acting Director of the Queensland Statewide AMS Program and runs the AMS program at Canberra Hospital & Health Services.