Evaluation of Staphylococcus aureus nasal carriage screening before vascular surgery.
BACKGROUND
Staphylococcus aureus is the most important pathogen in the development of surgical site infections (SSI). Patients who carry S. aureus in the nose are at increased risk for the development of SSI in cardiothoracic and orthopedic surgery. In these populations it has been shown that the risk for SSI can be substantially reduced by eradicating S. aureus carriage. For vascular surgery the relation between nasal carriage and surgical site infections has not been clearly investigated. For this reason we performed this study to analyze the relation between S. aureus nasal carriage and SSI in our vascular surgery population.


METHODS
A prospective cohort study was undertaken, including all patients undergoing vascular surgery between January first 2010 and December 31th 2010. Before surgery patients were screened for S. aureus nasal carriage using a PCR technique. The presence of SSI was recorded based on criteria of the CDC.


RESULTS
Screening was performed in 224. Of those, 55 (24.5%) were positive, 159 (71.0%) were negative and 10 (4.5%) were inconclusive. In the screened vascular population 4 S. aureus SSI occurred in the 55 carriers compared with 6 in 159 non-carriers (p=0.24). A stratified analysis revealed a 10-fold increased risk in nasal carriers undergoing central reconstruction surgery (3 S. aureus SSI in 20 procedures versus 1 in 65 procedures in non-carriers, p=0.039).


CONCLUSIONS
In patients undergoing central reconstruction surgery nasals carriers are at increased risk for the development of S. aureus SSI. These patients will probably benefit from perioperative treatment to eradicate nasal carriage.
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
Jeroen M W
JM
Donker
Lijckle
L
van der Laan
Yvonne J A M
YJ
Hendriks
Jan A J W
JA
Kluytmans
D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009296:Nasal Cavity / Q000382:microbiology / Q000601:surgery; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis*; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014656:Vascular Surgical Procedures / Q000379:methods*