Pre-cesarean Staphylococcus aureus nasal screening and decolonization: a prospective randomized controlled trial

Area of Science:

• Infectious Diseases
• Obstetrics & Gynecology
• Surgical Infections

Background:

• Staphylococcus aureus (S. aureus) is a significant cause of surgical site infections (SSIs).
• Mupirocin ointment effectively eradicates nasal S. aureus colonization in carriers.
• Preventing SSIs in cesarean sections (CS) is a critical clinical objective.

Purpose of the Study:

• To determine if pre-cesarean screening for nasal S. aureus carriage and subsequent decolonization with mupirocin reduces SSI rates.
• To evaluate the efficacy of a targeted decolonization strategy in preventing SSIs following CS.

Main Methods:

• A randomized controlled trial involving 568 patients undergoing CS.
• Participants were screened for nasal S. aureus colonization via nasal culture prior to surgery.
• Intervention group received mupirocin treatment for nasal S. aureus carriers; control group did not receive treatment.

Main Results:

• No significant difference in SSI rates between the intervention (13.1%) and control (12.1%) groups (p=0.78).
• S. aureus eradication rate with mupirocin was 88%.
• Previous CS was the sole independent predictor of SSI (OR 2.5, p=0.029).

Conclusions:

• Pre-operative screening and mupirocin decolonization for nasal S. aureus carriage do not effectively decrease SSI rates after cesarean sections.
• The study did not support the routine implementation of this screening and treatment protocol to prevent SSIs in CS patients.