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Updated: Mar 10, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Preoperative MRSA Screening in Pediatric Spine Surgery: A Helpful Tool or a Waste of Time and Money?
Scott J Luhmann1, June C Smith2
1Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA; St. Louis Children's Hospital, 1 Children's Place, St. Louis, MO 63110, USA; St. Louis Shriners Hospital, 4400 Clayton Ave, St. Louis, MO 63110, USA.
Objectives:
To review the use of preoperative screening for Staphylococcus aureus for all pediatric spine procedures that was instituted at our facility in a multimodal approach to decrease the frequency of postoperative wound infections.
Summary Of Background Data:
Four years ago at our facility, a multimodal approach to decrease the frequency of postoperative infections after pediatric spine surgery was instituted.
Methods:
A single-center, single-surgeon pediatric spine surgery database was queried to identify all patients who had preoperative S. aureus nasal swab screening. Data collected included demographic data, diagnoses, methicillin-resistant S. aureus (MRSA) swab findings, bacterial antibiotic sensitivities, and outcome of the spine surgery.
Results:
A total of 339 MRSA screenings were performed. Twenty (5.9%) were MRSA positive, and 55 (16.2%) were methicillin-sensitive S. aureus (MSSA) positive. In the MRSA-positive group, 13 were neuromuscular, 5 were adolescent idiopathic scoliosis (AIS), 1 congenital, and 1 infantile idiopathic scoliosis. Of the MRSA-positive screenings, 13 (65.0% of MRSA-positive screenings; 3.8% of entire cohort) of were newly identified cases (9 neuromuscular, 3 AIS, and 1 congenital diagnoses). In the 55 MSSA-positive, 6 documented resistance to either cefazolin or clindamycin. Hence, in up to 22 of the preoperative screenings (6.5% of entire cohort; 16 MRSA and 6 MSSA showed antibiotic resistance), the preoperative antibiotic regimen could be altered to appropriately cover the identified bacterial resistances. During the study period, there were 11 patients who were diagnosed with a postoperative deep wound infection, none of them having positive screenings.
Conclusion:
The use of preoperative nasal swab MRSA screening permitted adjustment of the preoperative antibiotic regimen in up to 6.5% of patients undergoing pediatric spine surgery. This inexpensive, noninvasive tool can be used in preoperative surgical planning for all patients undergoing spinal procedures.
Level Of Evidence:
Level IV.
Insights
Preoperative Staphylococcus aureus screening in pediatric spine surgery identified resistant bacteria in 6.5% of patients, allowing for adjusted antibiotic regimens. This noninvasive screening helps prevent postoperative wound infections.
Area of Science:
- Infectious Disease
- Pediatric Surgery
- Orthopedic Surgery
Background:
- Postoperative infections are a concern in pediatric spine surgery.
- A multimodal approach was implemented to reduce infection rates.
Purpose of the Study:
- To review the effectiveness of preoperative Staphylococcus aureus screening in pediatric spine surgery.
- To assess the impact of screening on reducing postoperative wound infections.
Main Methods:
- A single-center, single-surgeon database was queried for pediatric spine surgery patients.
- Preoperative Staphylococcus aureus nasal swab screening data were collected and analyzed.
- Outcomes included bacterial identification, antibiotic sensitivities, and surgical site infections.
Main Results:
- 339 screenings were performed; 5.9% were MRSA positive and 16.2% were MSSA positive.
- Antibiotic resistance was identified in up to 6.5% of patients, prompting regimen adjustments.
- No postoperative deep wound infections occurred in patients with positive screenings.
Conclusions:
- Preoperative Staphylococcus aureus screening allows for tailored antibiotic prophylaxis in pediatric spine surgery.
- This screening is an inexpensive, noninvasive tool for surgical planning.
- Screening can help decrease the frequency of postoperative wound infections.
