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Eradication of Staphylococcus aureus Post-Sternotomy Mediastinitis Following the Implementation of Universal

Rafael San-Juan1, Consuelo Alejandra Gotor-Pérez2, Francisco López-Medrano1

  • 1Unit of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Complutense University, Madrid, Spain.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|January 29, 2021
PubMed
Abstract

Insights

Presurgical nasal decontamination with mupirocin significantly reduced Staphylococcus aureus postsurgical mediastinitis. This intervention lowered the incidence of S. aureus infections following sternotomy procedures.

Area of Science:

  • Infectious Disease Epidemiology
  • Surgical Site Infection Prevention
  • Antimicrobial Stewardship

Background:

  • Postsurgical mediastinitis (PSM) due to Staphylococcus aureus is a serious complication.
  • Presurgical nasal decontamination with mupirocin (NDM) is proposed to prevent S. aureus PSM but lacks strong evidence.
  • The study evaluated the impact of preoperative NDM on S. aureus PSM incidence.

Purpose of the Study:

  • To assess the effectiveness of preoperative nasal decontamination with mupirocin in reducing Staphylococcus aureus postsurgical mediastinitis.
  • To analyze trends in S. aureus PSM before and after the implementation of NDM.

Main Methods:

  • An interrupted time-series analysis was conducted on a single-center cohort.
  • Data from 12,236 sternotomy procedures were analyzed, comparing preintervention (1990-2003) and postintervention (2005-2018) periods.
  • Logistic regression identified risk factors for S. aureus PSM.

Main Results:

  • The incidence of S. aureus PSM decreased from 19.31 to 0.68 per 1000 sternotomies post-NDM implementation (P < .0001).
  • Interrupted time-series analysis showed a significant annual reduction of 9.85 cases per 1000 sternotomies.
  • An 84.8% relative reduction in S. aureus PSM was estimated postintervention.

Conclusions:

  • Implementation of preoperative nasal decontamination with mupirocin significantly reduces the incidence of S. aureus PSM.
  • NDM is an effective strategy for preventing S. aureus surgical site infections in sternotomy patients.
  • Chronic obstructive pulmonary disease remains an independent risk factor for S. aureus PSM.
Keywords:
Staphylococcus aureusmupirocinnasal decontaminationpostsurgical mediastinitistime-series analysis

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