Rethinking Preoperative MRSA/MSSA Screening Through Molecular Triage

Area of Science:

• Microbiology
• Infectious Diseases
• Clinical Diagnostics

Background:

• Preoperative screening for MRSA and MSSA aims to prevent surgical site infections by guiding prophylaxis and decolonization.
• Current molecular assays often provide binary results, masking crucial details about organism identity and resistance.
• This limitation can obscure important clinical distinctions, impacting patient management strategies.

Purpose of the Study:

• To explore how MRSA/MSSA screening can evolve from simple organism detection to actionable molecular triage.
• To organize evidence around improving the clinical utility of preoperative S. aureus screening.
• To propose a framework for more nuanced molecular reporting.

Main Methods:

• A structured narrative review synthesizing perioperative, mechanistic, implementation, and economic evidence.
• Focused on the question of transitioning MRSA/MSSA screening to actionable molecular triage.
• Organized molecular patterns into provisional reportable categories.

Main Results:

• A proposed multi-target NAAT framework categorizes results including MSSA, MRSA, and methicillin-resistant non-aureus staphylococci.
• The framework also addresses mixed populations, SCCmec dropout patterns, and mupirocin resistance markers.
• Currently, no validated rules link all categories to specific perioperative actions.

Conclusions:

• Moving beyond binary reporting in MRSA/MSSA screening could enhance clinical decision-making.
• The presented framework is a development-stage tool, not a validated clinical instrument.
• Further validation, including analytical thresholds and prospective clinical studies, is essential before widespread implementation.