Related Experiment Video
Updated: Oct 27, 2025
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Nasal screening for methicillin-resistant Staphylococcus aureus does not reduce surgical site infection after primary
Grace X Xiong1, Nattaly E Greene1, Stuart H Hershman2
1Harvard Combined Orthopedic Residency Program, Boston, MA, USA.
Background Context:
Preoperative methicillin-resistant Staphylococcus aureus (MRSA) testing and decolonization has demonstrated success for arthroplasty patients in surgical site infections (SSIs) prevention. Spine surgery, however, has seen varied results.
Purpose:
The purpose of this study was to determine the impact of nasal MRSA testing and operative debridement rates on surgical site infection after primary lumbar fusion.
Study Design/Setting:
Retrospective cohort study and/or Consolidated medical enterprise PATIENT SAMPLE: Adult patients undergoing primary instrumented lumbar fusions from January 2015 to December 2019 were reviewed.
Outcome Measures:
The primary outcome was incision and drainage performed in the operating room within 90 days of surgery.
Methods:
MRSA testing <90-day's before surgery, mupirocin prescription <30-day's before surgery, perioperative antibiotics, and Elixhauser comorbidity index were collected for each subject. Bivariate analysis used Wilcoxon rank-sum testing and logistic regression modeling Multivariable logistic regression modeling assessed for associations with MRSA testing, intravenous vancomycin use, and I&D rate.
Results:
The study included 1,884 patients for analysis, with mean age of 63.1 (SE 0.3) and BMI 29.5 (SE 0.1). MRSA testing was performed in 755 patients (40.1%) and was more likely to be performed in patients with lower Elixhauser index scores (OR 0.98, 95% CI 0.96-0.99, p=.021) on multivariable analysis. Vancomycin use increased significantly over time (OR 1.49 and/or year, 95% CI 1.3-1.8, p<.001) despite no change in mupirocin or I&D rates. MRSA testing, mupirocin prescriptions, perioperative parenteral vancomycin use, and intrawound vancomycin powder use had no impact on I&D rates. I&D risk was associated with higher BMI (OR 1.06, 95% CI 1.02-1.12, p=.009) and higher number of blood product units transfused (OR 1.23, 95% CI 1.03-1.46, p=.022).
Conclusions:
The present study demonstrates no impact on surgical I&D rates from the use of preoperative MRSA testing. Increased BMI and transfusions were associated with operative I&D rates for surgical site infection. As a result of the hospital directive, vancomycin use increased over time with no associated change in infection rates, underscoring the need for focused interventions, and engagement with antibiotic stewardship programs.
Insights
Preoperative methicillin-resistant Staphylococcus aureus (MRSA) testing did not impact surgical site infection rates in primary lumbar fusion. Higher BMI and blood transfusions were associated with increased infection risk.
Area of Science:
- Neurosurgery
- Infectious Disease
- Public Health
Background:
- Preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening and decolonization are effective in preventing surgical site infections (SSIs) in arthroplasty.
- However, the efficacy of these interventions in spine surgery remains inconsistent.
Purpose of the Study:
- To evaluate the effect of nasal MRSA testing and operative debridement on the incidence of SSIs following primary lumbar fusion.
Main Methods:
- A retrospective cohort study analyzed adult patients who underwent primary instrumented lumbar fusion between January 2015 and December 2019.
- Data collected included MRSA testing, mupirocin prescription, perioperative antibiotics, and Elixhauser comorbidity index.
- Logistic regression modeling assessed associations with MRSA testing, vancomycin use, and incision and drainage (I&D) rates.
Main Results:
- Of 1,884 patients, 40.1% underwent MRSA testing, more common in patients with lower comorbidity scores.
- Vancomycin use increased significantly over time, unrelated to mupirocin use or I&D rates.
- MRSA testing, mupirocin, and vancomycin use did not affect I&D rates. Higher BMI and blood transfusions were linked to increased I&D risk.
Conclusions:
- Preoperative MRSA testing showed no significant impact on surgical I&D rates in primary lumbar fusion.
- Increased BMI and blood transfusions are risk factors for operative I&D.
- Rising vancomycin use, driven by hospital policy, did not correlate with reduced infection rates, highlighting the need for antibiotic stewardship.
