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Updated: Feb 8, 2026
Development and Assessment of Intracellular Infection Models for Staphylococcus aureus
Published on: January 17, 2025
Staphylococcus aureus colonization and risk of surgical site infection in children undergoing clean elective surgery:
Susanna Esposito1, Leonardo Terranova, Francesco Macchini
1Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia Pediatric Highly Intensive Care Unit, Università degli Studi di Milano Unit for Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
Insights
Children carrying Staphylococcus aureus (S aureus) do not face an increased risk of surgical site infections after clean elective surgery. Preoperative screening for S aureus in these pediatric patients is not necessary, simplifying procedures and offering clinical, social, and economic benefits.
Area of Science:
- Clinical microbiology and infectious diseases.
- Pediatric surgery and hospital-acquired infections.
Background:
- Staphylococcus aureus colonization affects 20-30% of individuals, particularly children.
- Screening and decolonization are recommended for surgical patients to prevent infections and spread, but optimal approaches for clean surgery remain unclear.
Purpose of the Study:
- To determine if S aureus colonization increases the risk of postoperative surgical site infections in children undergoing clean elective surgery.
Main Methods:
- 393 children scheduled for clean elective surgery were screened for S aureus carriage (nares and pharynx) on admission and 5 days post-intervention.
- S aureus and methicillin-resistant S aureus (MRSA) identification used the RIDAGENE MRSA system.
- Surgical site infections (SSIs) were monitored postoperatively.
Main Results:
- 35.1% of children screened positive for S aureus upon admission; MRSA was found in 29% of these cases.
- S aureus and MRSA carriage rates varied by age, being lower in children under 2 years old.
- SSIs occurred in 3.7% of S aureus-positive children and 2.5% of S aureus-negative children, with no statistically significant difference (P=.72). No MRSA-related SSIs were observed.
Conclusions:
- Pediatric patients undergoing clean elective surgery do not appear to have an increased risk of surgical site infections due to S aureus colonization.
- Routine preoperative S aureus screening for these children is likely unnecessary, potentially simplifying preoperative protocols and yielding clinical, social, and economic advantages.
Abstract:
Staphylococcus aureus persistently colonizes the skin and nasopharynx of approximately 20% to 30% of individuals, with the highest rates in younger children. To avoid clinical problems for carriers and the spread of S aureus to other hospitalized patients, screening and decolonization of carriers undergoing surgery has been recommended. However, the best approach to patients undergoing clean surgery is not precisely defined. To evaluate whether children carrying S aureus admitted to the hospital for clean elective surgery have an increased risk of postoperative surgical infections, 393 infants and children (77.1% males; mean age ± standard deviation, 7.6 ± 4.5 years) who were scheduled for clean elective surgery procedures were evaluated for S aureus carriage on the day of intervention and 5 days after it. Both anterior nares and pharyngeal swabs were collected. S aureus was identified using the RIDAGENE methicillin-resistant S aureus (MRSA) system (R-Biopharm AG, Darmstadt, Germany), according to the manufacturer's instructions. At admission, 138 (35.1%) children screened positive for S aureus. MRSA was identified in 40 (29.0% of S aureus positive subjects) cases. The carriage rates of S aureus and MRSA varied considerably with age, and in children <2 years old the rate was significantly lower than in any other age group (P < .05). Surgical site infection was demonstrated in 4 out of 109 (3.7%) children who were initially colonized by S aureus and in 5 out of 201 (2.5%) children with a negative screening, without any statistically significant difference between groups (P = .72). None of these children had MRSA. These results seem to suggest that children undergoing clean elective surgery do not need to be screened for S aureus colonization because, although positive, they have no increased risk of surgical site infection. Following this statement, preoperative procedures should be simplified with relevant advantages from a clinical, social, and economic point of view.
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