PIAC Case Series
Iowa Lutheran Family Medicine Residency Program

PIAC Case Series

Case 03 - Owen, 58 years old

Owen is a 58 y/o who underwent ORIF L tibia and fibula following a closed ankle fracture. He is readmitted 6 days post-op with wound dehiscence, drainage and surrounding cellulitis

Blood cultures are negative but wound cultures show PMN and gm + cocci on gm stain and grow MRSA


1) What isolation precautions should be taken to prevent spread of MRSA in the hospital?

  • Should staff wear masks to enter?
  • Should staff or other patients be cultured?

2) The patient undergoes debridement with removal of hardware and placement of external fixator; he is responding to iv vancomycin. Because of pre-existing DJD, a R total knee replacement is scheduled in 6 months. The patient, his family and doctors have several questions.

  • Does MRSA pose a risk to his family/friends?
  • What are the criteria for discontinuation of contact precautions?
  • What measures can be undertaken to decrease risk of MRSA infection at TKA site?

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