Staphylococcus aureus and surgical site infections: benefits of screening and decolonization before surgery

Area of Science:

• Infectious Diseases
• Surgical Infections
• Microbiology

Background:

• Surgical site infections (SSIs) are common healthcare-associated infections, with Staphylococcus aureus being the primary causative agent.
• The epidemiology of Staphylococcus aureus is evolving, marked by the spread of new strains and increasing mupirocin resistance.
• Effective prevention and control of SSIs require a comprehensive, multi-faceted strategy.

Purpose of the Study:

• To review the evidence supporting pre-operative screening for Staphylococcus aureus nasal carriage.
• To evaluate the efficacy of decolonization protocols for patients identified as carriers.
• To discuss the implications of these strategies on SSI rates and antibiotic resistance.

Main Methods:

• Review of existing literature on Staphylococcus aureus screening and decolonization.
• Analysis of studies utilizing culture- or molecular-based screening methods.
• Assessment of decolonization outcomes in patients undergoing various surgical procedures.

Main Results:

• Pre-operative screening and decolonization of Staphylococcus aureus carriers (including MRSA) demonstrably reduce SSIs and shorten hospital stays.
• These benefits are particularly pronounced in major clean surgeries, such as cardiothoracic and orthopedic procedures, especially those involving implants.
• A multidisciplinary approach and patient education are essential for successful implementation.

Conclusions:

• Pre-operative screening and targeted decolonization of Staphylococcus aureus carriers are effective strategies for SSI prevention.
• Universal pre-operative decolonization without screening poses risks, including masking emerging strains and exacerbating antibiotic resistance.
• Careful consideration of screening versus universal decolonization is necessary to optimize SSI control and antimicrobial stewardship.