Surveillance of nasal Staphylococcus aureus in patients undergoing breast surgery

Screening and decolonization programs have proven effective in reducing the frequency of Staphylococcus aureus infections, mainly in orthopedic and cardiac procedures. Despite being classified as clean, breast surgery is associated with infection. Using culture and polymerase chain reaction (PCR) assay, we aimed to assess the frequency of nasal carriage of S. aureus in patients undergoing breast surgery. We conducted a prospective observational 10-month study at a large tertiary teaching hospital, including patients undergoing breast reconstruction surgery who met the eligibility criteria and signed the informed consent document. Nasal swabs were collected before surgery from patients with no signs of S. aureus infection and tested using both culture and the Xpert MRSA/SA SSTI PCR assay. The outcomes were nasal colonization by S. aureus, colonization rates at the time of surgery, infection, and length of hospital stay. We included 100 patients, 27% of whom were colonized. Of these, 20 patients were positive by culture and 27 by PCR. The median (IQR) age was 56.0 (49.0-63.7) years. A total of 6 patients had infection, and the median (IQR) number of days until onset of infection was 191 (186.25-197.00). Carriage of S. aureus before surgery was microbiologically confirmed in two patients. We demonstrated that 27% of patients undergoing breast surgery were nasal carriers of S. aureus, with PCR assay being the best diagnostic strategy. Future studies are needed to address the efficacy of bacterial decolonization of the nose and nipples to reduce the frequency of infection and complications.

We showed that almost 30% of women undergoing breast surgery are nasal carriers of S. aureus, and PCR molecular technique was the best diagnostic tool. However, future studies are needed to implement decolonization of nasal and nipple to reduce infection and complications.