Summary
Introduction
Sternal wound infection (SWI) after cardiac surgery is a severe complication. Among
preventive measures, pre-operative decolonization of nasal carriage of Staphylococcus aureus has recently been shown to be beneficial. This quasi-experimental study assessed
the effect of decolonization on the incidence of S. aureus-associated SWI based on 19 years of prospective surveillance.
Methods
Segmented negative binomial regression was used to analyse the change over time in
the incidence of S. aureus mediastinitis requiring re-operation after cardiac surgery in a French university
hospital between 1996 and 2014. Universal nasal decolonization with mupirocin was
introduced in December 2001. The association between pre-operative nasal carriage
and SWI due to S. aureus was analysed between 2006 and 2012.
Results
Among 17,261 patients who underwent a cardiac surgical procedure, 565 developed SWI
(3.3%), which was caused by S. aureus in 181 cases (1%). The incidence of mediastinitis caused by S. aureus decreased significantly over the study period (1.43% in 1996–2001 vs 0.61% and 0.64%
in 2002–2005 and 2006–2014, respectively; P<0.001). In segmented analysis, there was a significant break in 2002, corresponding
to the introduction of decolonization. Despite this intervention, pre-operative nasal
carriage remained a significant risk factor for S. aureus mediastinitis (adjusted odds ratio 2.2; 95% confidence interval 1.2–4.2), as were
obesity, critical pre-operative status, coronary artery bypass grafting (CABG), and
combined surgery with valve replacement and CABG.
Conclusion
Universal nasal decolonization before cardiac surgery was effective in decreasing
the incidence of mediastinitis caused by S. aureus. Nasal carriage of S. aureus remained a risk factor for S. aureus-associated SWI.
Keywords
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Article info
Publication history
Published online: May 04, 2018
Accepted:
April 30,
2018
Received:
February 1,
2018
Identification
Copyright
© 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
