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Updated: May 14, 2026

Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
12:18

Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)

Published on: February 9, 2011

Nasal carriage of Staphylococcus aureus in patients undergoing Mohs micrographic surgery is an important risk factor

Yee J Tai1, Kate L A Borchard, Todd H Gunson

  • 1Oxford Day Surgery and Dermatology, Perth, Western Australia, Australia. yeejentai@yahoo.com

The Australasian Journal of Dermatology
|February 22, 2013
PubMed
Abstract

Insights

Nasal Staphylococcus aureus (S. aureus) carriage significantly increases surgical site infection (SSI) risk in Mohs surgery. Topical decolonization effectively reduces SSI rates in S. aureus carriers.

Area of Science:

  • Dermatologic surgery
  • Infectious disease epidemiology
  • Surgical outcomes research

Background:

  • Surgical site infection (SSI) is a significant complication following Mohs micrographic surgery (MMS).
  • Nasal Staphylococcus aureus (S. aureus) carriage is a known risk factor for SSI, but its specific impact in dermatologic surgery requires further investigation.
  • Understanding S. aureus carriage prevalence and its association with SSI is crucial for improving patient safety in MMS.

Purpose of the Study:

  • To determine the difference in SSI rates between nasal S. aureus carriers and non-carriers undergoing MMS.
  • To evaluate the efficacy of a decolonization regimen (intranasal mupirocin and chlorhexidine wash) in reducing SSI rates among S. aureus carriers.
  • To assess the utility of pre-operative nasal swabs for risk stratification of SSI in MMS patients.

Main Methods:

  • A prospective study involving 738 patients undergoing MMS at Oxford Day Surgery and Dermatology.
  • Patients provided nasal swabs for S. aureus carriage status determination.
  • S. aureus carriers were randomized to receive either a topical decolonization regimen or no treatment, while non-carriers remained untreated. All patients were monitored for SSI development.

Main Results:

  • The SSI rate was 11% in untreated S. aureus carriers, 4% in treated carriers, and 3% in non-carriers.
  • A significant difference in SSI rates was observed between S. aureus carriers and non-carriers (P < 0.001).
  • The decolonization regimen significantly reduced SSI rates in carriers compared to untreated carriers (P = 0.05).

Conclusions:

  • Nasal S. aureus carriage is a significant risk factor for SSI in Mohs micrographic surgery, increasing risk over threefold.
  • Pre-operative nasal swabbing is a simple and effective tool for stratifying SSI risk in MMS patients.
  • Topical decolonization effectively lowers SSI rates in carriers, approaching those of non-carriers without systemic antibiotic use.

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