Summary
Surgical site infections (SSIs) are among the most common healthcare-associated infections,
and contribute significantly to patient morbidity and healthcare costs. Staphylococcus aureus is the most common microbial cause. The epidemiology of S. aureus is changing with the dissemination of newer clones and the emergence of mupirocin
resistance. The prevention and control of SSIs is multi-modal, and this article reviews
the evidence on the value of screening for nasal carriage of S. aureus and subsequent decolonization of positive patients pre-operatively. Pre-operative
screening, using culture- or molecular-based methods, and subsequent decolonization
of patients who are positive for meticillin-susceptible S. aureus and meticillin-resistant S. aureus (MRSA) reduces SSIs and hospital stay. This applies especially to major clean surgery,
such as cardiothoracic and orthopaedic, involving the insertion of implanted devices.
However, it requires a multi-disciplinary approach coupled with patient education.
Universal decolonization pre-operatively without screening for S. aureus may compromise the capacity to monitor for the emergence of new clones of S. aureus, contribute to mupirocin resistance, and prevent the adjustment of surgical prophylaxis
for MRSA (i.e. replacement of a beta-lactam agent with a glycopeptide or alternative).
Keywords
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Article info
Publication history
Published online: June 18, 2016
Accepted:
June 6,
2016
Received:
February 26,
2016
Identification
Copyright
© 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
