Preoperative methicillin-resistant Staphylococcus aureus screening in Mohs surgery appears to decrease postoperative infections.
BACKGROUND
Colonization with methicillin-resistant Staphylococcus aureus (MRSA) places patients at risk for postoperative MRSA wound infections.


OBJECTIVE
To determine the effect of a decontamination and prophylaxis protocol on postoperative MRSA wound infections in patients with nasal MRSA.


METHODS
Wound cultures over a 23-month period were reviewed before and 11 months after implementation of a screening and decontamination protocol. After preoperative MRSA screening with nasal swabs, carriers were instructed to use intranasal mupirocin for 5 to 7 days before surgery and 5 to 7 days of trimethoprim-sulfamethoxazole starting the day before surgery.


RESULTS
During the 23 months before prescreening evaluation, we performed 3,633 Mohs surgical cases, and 12 postoperative MRSA wound infections (0.3%) occurred. Subsequently, 963 patients underwent screening for MRSA, and 23 MRSA carriers were identified (2.4%). Of the 22 who underwent the decontamination and treatment protocol, none developed postoperative wound infections. One MRSA carrier did not receive preoperative treatment and subsequently developed a MRSA wound infection. There were no other MRSA infections.


CONCLUSIONS
Preoperative MRSA screening and implementation of a decontamination protocol appears to decrease postoperative MRSA wound infections after Mohs surgery. Although an interesting observation, controlled studies of clinical and cost effectiveness are required before general implementation. The authors have indicated no significant interest with commercial supporters.
Cordova
Katharine B
KB
Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA.
Grenier
Nicole
N
Chang
Kyung Hee
KH
Dufresne
Raymond
R
D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D002353:Carrier State / Q000175:diagnosis; D003666:Decontamination / Q000379:methods; D006787:Hospitals, Veterans; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008403:Mass Screening / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015580:Mohs Surgery / Q000009:adverse effects*; D016712:Mupirocin / Q000008:administration & dosage; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D016712:Mupirocin