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Staphylococcus Aureus Swabbing and Decolonization Before Neuromodulation Procedures: A Systematic Review and
Neal Patel1, Justin Gold2, Nolan J Brown3
1School of Medicine, Mercer University, Columbus, GA, USA.
Introduction:
Staphylococcus aureus (S aureus) is the foremost bacterial cause of surgical-site infection (SSI) and is a common source of neuromodulation SSI. Endogenous colonization is an independent risk factor for SSI; however, this risk has been shown to diminish with screening and decolonization.
Materials And Methods:
A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed, Cochrane Library, and Embase data bases from inception to January 1, 2022, for the purposes of identifying all studies reporting on the use of S aureus swabbing and/or decolonization before neuromodulation procedures. A random-effects meta-analysis was performed using the metaphor package in R to calculate odds ratios (OR).
Results:
Five observational cohort studies were included after applying the inclusion and exclusion criteria. The average study duration was 6.6 ± 3.8 years. Three studies included nasal screening as a prerequisite for subsequent decolonization. Type of neuromodulation included spinal cord stimulation in two studies, deep brain stimulation in two studies, intrathecal baclofen in one study, and sacral neuromodulation in one study. Overall, 860 and 1054 patients were included in a control or intervention (ie, screening and/or decolonization) group, respectively. A combination of nasal mupirocin ointment and a body wash, most commonly chlorhexidine gluconate soap, was used to decolonize throughout. Overall infection rates were observed at 59 of 860 (6.86%) and ten of 1054 (0.95%) in the control and intervention groups, respectively. Four studies reported a significant difference. The OR for intervention (screen and/or decolonization) vs no intervention was 0.19 (95% CI, 0.09-0.37; p < 0.001). Heterogeneity between studies was nonsignificant (I2 = 0.43%, τ2 = 0.00).
Conclusions:
Preoperative S aureus swabbing and decolonization resulted in significantly decreased odds of infection in neuromodulation procedures. This measure may represent a worthwhile tool to reduce neuromodulation SSI, warranting further investigation.
Insights
Preoperative screening and decolonization for Staphylococcus aureus (S aureus) significantly reduce surgical-site infection (SSI) risk in patients undergoing neuromodulation procedures. This intervention is a valuable tool for preventing S aureus SSIs.
Area of Science:
- Infectious Disease Epidemiology
- Surgical Site Infection Prevention
- Neuromodulation Procedures
Background:
- Staphylococcus aureus (S aureus) is a primary cause of surgical-site infections (SSIs), particularly in neuromodulation procedures.
- Endogenous S aureus colonization is a significant risk factor for developing SSIs.
- Preoperative screening and decolonization strategies can mitigate this risk.
Approach:
- A systematic review and random-effects meta-analysis were conducted, adhering to PRISMA guidelines.
- Searched PubMed, Cochrane Library, and Embase databases for studies on S aureus screening/decolonization before neuromodulation.
- Included five observational cohort studies, analyzing data up to January 1, 2022.
Key Points:
- The intervention group (screening and/or decolonization) had significantly lower infection rates (0.95%) compared to the control group (6.86%).
- The odds ratio for intervention versus no intervention was 0.19 (95% CI, 0.09-0.37; p < 0.001), indicating a strong protective effect.
- Common decolonization involved nasal mupirocin and chlorhexidine body wash; neuromodulation types included spinal cord and deep brain stimulation.
Conclusions:
- Preoperative S aureus screening and decolonization demonstrably decrease the odds of infection following neuromodulation procedures.
- This approach is a promising strategy for reducing neuromodulation-associated SSIs.
- Further research is warranted to fully establish the efficacy and implementation of these measures.
