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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
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Staphylococcus aureus colonization in children undergoing heart surgery.

Sydney T Costantini1, Donna Lach, Johanna Goldfarb

  • 1Center for Pediatric Infectious Diseases, The Cleveland Clinic, Cleveland, OH, USA.

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|December 12, 2013
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Screening pediatric cardiac surgery patients for methicillin-resistant Staphylococcus aureus (MRSA) in two locations, the nose and groin, increases detection rates. This dual-site screening identifies more MRSA cases than nasal screening alone.

Keywords:
MRSAStaphylococcus aureuscolonizationcongenital heart surgerygroininfectionmediastinal infectionmethicillin-resistant S. aureusnasalpediatricscreeningwound infection

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Area of Science:

  • Infectious Diseases
  • Pediatric Surgery
  • Microbiology

Background:

  • Staphylococcus aureus is a significant cause of cardiac surgical site infections.
  • Nasal screening for S aureus colonization guides decolonization and antibiotic selection in adults.
  • Pediatric cardiac surgery patients are screened for nasal methicillin-sensitive S aureus (MSSA) and methicillin-resistant S aureus (MRSA) via PCR, with groin cultures for MRSA in diapered patients.

Purpose of the Study:

  • To determine if screening two anatomic locations (nose and groin) increases MRSA detection rates in pediatric cardiac surgery patients.

Main Methods:

  • Retrospective chart review of 322 pediatric cardiac surgery procedures (January 2009 - June 2011).
  • Preoperative nasal PCR and a second anatomic site culture were performed for 102 procedures.
  • Analysis of MRSA colonization frequency by anatomic site.

Main Results:

  • Overall MRSA and MSSA colonization rates were 4.2% and 29.1%, respectively.
  • Of seven MRSA-positive patients, two were identified only by groin culture, four by nasal screening alone, and one by both.
  • Nasal screening alone would have missed 28.6% of MRSA cases.

Conclusions:

  • Screening both the nose and a second anatomic site may improve preoperative MRSA detection in pediatric cardiac surgery patients.
  • The clinical utility of extranasal MRSA cultures was limited by long assay turnaround times.