Rapid colonization with methicillin-resistant coagulase-negative staphylococci after surgery.
BACKGROUND
Antimicrobial resistance may compromise the efficacy of antibiotic prophylaxis before surgery. The aim of this study was to measure susceptibility and clonal distribution of coagulase-negative staphylococci (CoNS) colonizing the skin around the surgery access site before and after the procedure.


METHODS
From March to September 2004, a series of 140 patients undergoing elective major abdominal surgery were screened for CoNS colonization at admission and 5 days after surgery. All isolates were tested for antibiotic susceptibility and genotyped by pulsed-field gel electrophoresis (PFGE).


RESULTS
Colonization rates with CoNS at admission and after surgery were 85% and 55%, respectively. The methicillin-resistant CoNS rate increased from 20% at admission to 47% after surgery (P = 0.001). The PFGE pattern after surgery revealed more patients colonized with identical clones: 8/140 patients (8/119 strains) and 26/140 patients (26/77 strains), respectively (P < 0.001).


CONCLUSIONS
Our results suggest rapid recolonization of disinfected skin by resistant nosocomial CoNS. Larger studies, preferably among orthopedic or cardiovascular patients, are required to clarify whether standard antibiotic prophylaxis with first- or second-generation cephalosporins for CoNS infections may be compromised if the patient requires an additional intervention 5 days or more after the initial surgery.
Zingg
Walter
W
Division of Infectious Diseases and Hospital Epidemiology, Department of Medicine, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. walter.zingg@hcuge.ch
Demartines
Nicolas
N
Imhof
Alexander
A
Senn
Gabriela
G
Ruef
Christian
C
D034861:Abdominal Wall / Q000382:microbiology; D000328:Adult; D003030:Coagulase; D015331:Cohort Studies; D062109:Dermatologic Surgical Procedures; D004203:Disinfection; D017558:Elective Surgical Procedures; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology*; D013207:Staphylococcal Skin Infections / Q000382:microbiology*; D013514:Surgical Procedures, Operative
D003030:Coagulase