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Updated: Mar 17, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Methicillin-Resistant Staphylococcus aureus Infections: A Comprehensive Review and a Plastic Surgeon's Approach to
Cedric Hunter1,2, Lorne Rosenfield1,2, Elena Silverstein1,2
1Palo Alto, Burlingame, and Hillsborough, Calif.
Background:
Up to 20 percent of the general population is persistently colonized with Staphylococcus aureus, and 1 to 3 percent of the population is colonized with community-acquired methicillin-resistant S. aureus. Currently, the knowledge of methicillin-resistant Staphylococcus aureus carriage sites other than the nose, and their effect on surgical site infections in cosmetic surgery, is lacking.
Methods:
A comprehensive literature review using the PubMed database to analyze prevalence, anatomical carrier sites, current screening and decontamination protocols and guidelines, and methicillin-resistant S. aureus in cosmetic surgery was performed. The senior author's (L.R.) methicillin-resistant S. aureus infection experience and prevention protocols were also reviewed.
Results:
Nasal swabs detect only 50.5 percent of methicillin-resistant S. aureus colonization, and broad screening has noted the presence of methicillin-resistant S. aureus in the ear canal and umbilicus. Decolonization protocols within the orthopedic and cardiothoracic surgery literature have reduced rates of methicillin-resistant S. aureus surgical-site infections. There are no decolonization guidelines for plastic surgeons. Since instituting their decolonization protocol, the authors have had no cases of methicillin-resistant S. aureus infection in nearly 1000 cosmetic surgery procedures.
Conclusions:
There are very limited, if any, Level I or II data regarding methicillin-resistant S. aureus screening and decolonization. As the sequelae of a surgical-site infection can be disastrous, expert opinions recommend that plastic surgeons vigorously address methicillin-resistant S. aureus colonization and infection. The authors have developed and recommend a simple decolonization protocol that includes treatment of the umbilicus, ear canal, and nares to limit surgical-site infection and improve surgical outcomes.
Insights
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization is common. Addressing extra-nasal sites like the umbilicus and ear canal can reduce surgical site infections in cosmetic surgery.
Area of Science:
- Infectious Disease
- Plastic Surgery
- Microbiology
Background:
- Up to 20% of the population carries Staphylococcus aureus.
- 1-3% of the population is colonized with community-acquired methicillin-resistant S. aureus (CA-MRSA).
- Limited data exists on CA-MRSA carriage sites beyond the nose and their impact on cosmetic surgery site infections.
Purpose of the Study:
- To review the prevalence and anatomical carriage sites of CA-MRSA.
- To analyze current screening and decontamination protocols for CA-MRSA.
- To evaluate the effectiveness of decolonization in preventing surgical site infections in cosmetic surgery.
Main Methods:
- Comprehensive literature review of PubMed database.
- Analysis of prevalence, anatomical carrier sites, and existing CA-MRSA screening/decontamination protocols.
- Review of senior author's experience and prevention protocols for CA-MRSA infections.
Main Results:
- Nasal swabs detect only 50.5% of CA-MRSA colonization.
- CA-MRSA has been identified in the ear canal and umbilicus.
- Decolonization protocols in other surgical fields have reduced CA-MRSA surgical-site infections; authors experienced no CA-MRSA infections in nearly 1000 procedures after implementing a protocol.
Conclusions:
- Limited high-level data exists for CA-MRSA screening and decolonization in plastic surgery.
- Expert opinion recommends aggressive management of CA-MRSA colonization due to potential for disastrous surgical site infections.
- A simple decolonization protocol targeting the umbilicus, ear canal, and nares is recommended to improve outcomes.
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