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Staphylococcus aureus colonization and surgical site infections among patients undergoing surgical fixation for acute

Megan Ahmann1,2, Jocelyn Compton3,4, Jean Pottinger5

  • 1State Hygienic Laboratory at the University of Iowa, Coralville, IA, USA.

Infection Control and Hospital Epidemiology
|February 14, 2025
PubMed
Abstract

Insights

Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage significantly increases the risk of surgical site infections (SSI) after fracture fixation surgery. Many patients did not receive decolonization treatment, indicating a need for improved protocols.

Area of Science:

  • Infectious Diseases
  • Orthopedic Surgery
  • Public Health

Background:

  • Staphylococcus aureus nasal carriage is a risk factor for surgical site infections (SSI).
  • Methicillin-resistant S. aureus (MRSA) poses a significant threat in healthcare settings.
  • Effective decolonization strategies are crucial for preventing SSIs in orthopedic surgery.

Purpose of the Study:

  • To identify risk factors for methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage.
  • To determine the association between S. aureus nasal carriage and SSI after fracture fixation.
  • To evaluate the effectiveness of a quality improvement protocol for S. aureus decolonization.

Main Methods:

  • Retrospective cohort study of 1,254 adult patients undergoing fracture fixation.
  • Screening for S. aureus nasal carriage and analysis of SSI rates.
  • Multivariable logistic regression to identify risk factors and associations.

Main Results:

  • MRSA nasal carriage was associated with increased risk of SSI (OR 4.58), S. aureus SSI (OR 10.11), and MRSA SSI (OR 27.25).
  • Long-term care facility residence was a risk factor for MRSA carriage (OR 3.38).
  • MSSA carriage was not significantly associated with SSI; many carriers did not receive mupirocin or chlorhexidine treatment.

Conclusions:

  • MRSA nasal carriage is a significant risk factor for SSI following operative fracture fixation.
  • Current decolonization protocols are not universally applied, necessitating simplification.
  • Targeted decolonization strategies are essential for reducing SSI in orthopedic patients.

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