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Preoperative Staphylococcus Aureus Screening and Targeted Decolonization in Cardiac Surgery
Manoj K Saraswat1, Jonathan T Magruder1, Todd C Crawford1
1Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
The Annals of Thoracic Surgery
|June 5, 2017
Summary
Preoperative screening for Staphylococcus aureus and targeted decolonization significantly reduced MRSA colonization, transmission, and surgical site infections in cardiac surgery patients. Longer decolonization therapy duration further decreased postoperative MRSA colonization rates.
Area of Science:
- Infectious Disease Epidemiology
- Surgical Site Infection Prevention
- Antimicrobial Stewardship
Background:
- Assessing the impact of preoperative Staphylococcus aureus screening and targeted decolonization strategies.
- Focusing on reducing methicillin-resistant S aureus (MRSA) colonization, transmission, and surgical site infections (SSIs) in cardiac surgery.
- Evaluating outcomes in adult patients undergoing cardiac surgery.
Purpose of the Study:
- To determine the effectiveness of a preoperative S. aureus screening and decolonization program.
- To reduce the incidence of MRSA colonization, ICU transmission, and SSIs post-cardiac surgery.
- To identify risk factors for MRSA colonization and SSIs and assess the screening program's impact.
Main Methods:
- Retrospective review of medical records for adult cardiac surgery patients (preintervention: Jan 2007-Apr 2010; intervention: Jan 2011-Dec 2014).
- Nasal PCR screening for S. aureus and MRSA; decolonization with mupirocin/chlorhexidine for S. aureus, adding vancomycin/cefazolin for MRSA.
- Multivariable logistic and Poisson regression models to analyze risk factors, SSI rates, and MRSA transmission.
Main Results:
- Intervention group (4,038 patients) showed risk-adjusted reductions in MRSA colonization (OR 0.53), transmission (IRR 0.29), and SSIs (OR 0.58) compared to preintervention (2,826 patients).
- Increased duration of preoperative decolonization therapy correlated with decreased postoperative MRSA colonization (OR 0.73).
- Significant differences (p ≤ 0.03) noted in baseline characteristics between groups, including age and preoperative infection.
Conclusions:
- Preoperative S. aureus screening and targeted decolonization effectively reduce MRSA colonization, transmission, and SSIs in cardiac surgery.
- The duration of preoperative decolonization therapy is inversely associated with postoperative MRSA colonization.
- Implementation of such screening programs is crucial for enhancing patient safety and reducing healthcare-associated infections.
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