title: Comprehensive review of methicillin-resistant Staphylococcus aureus: screening and preventive recommendations for plastic surgeons and other surgical health care providers.
abstract: BACKGROUND
  Up to 2.3 million people are colonized with methicillin-resistant Staphylococcus aureus in the United States, causing well-documented morbidity and mortality. Although the association of clinical outcomes with community and hospital carriage rates is increasingly defined, less is reported about asymptomatic colonization prevalence among physicians, and specifically plastic surgeons and the subsequent association with the incidence of patient surgical-site infection.
  
  
  METHODS
  A review of the literature using the PubMed and Cochrane databases analyzing provider screening, transmission, and prevalence was undertaken. In addition, a search was completed for current screening and decontamination guidelines and outcomes.
  
  
  RESULTS
  The methicillin-resistant S. aureus carriage prevalence of surgical staff is 4.5 percent. No prospective data exist regarding transmission and interventions for plastic surgeons. No studies were found specifically looking at prevalence or treatment of plastic surgeons. Current recommendations by national organizations focus on patient-oriented point-of-care testing and intervention, largely ignoring the role of the health care provider. Excellent guidelines exist regarding screening, transmission prevention, and treatment both in the workplace and in the community. No current such guidelines exist for plastic surgeons.
  
  
  CONCLUSIONS
  No Level I or II evidence was found regarding physician screening, treatment, or transmission. Current expert opinion, however, indicates that plastic surgeons and their staff should be vigilant for methicillin-resistant S. aureus transmission, and once a sentinel cluster of skin and soft-tissue infections is identified, systematic screening and decontamination should be considered. If positive, topical decolonization therapy should be offered. In refractory cases, oral antibiotic therapy may be required, but this should not be used as a first-line strategy.
authors.affiliation: Dallas, Texas; and San Diego, Calif. From the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the Division of Infectious Diseases, Naval Medical Center San Diego.
authors.forename: Eamon B
authors.initials: EB
authors.lastname: O'Reilly
authors.forename: Mark D
authors.initials: MD
authors.lastname: Johnson
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D020380:Needs Assessment; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D013518:Surgery, Plastic / Q000009:adverse effects* / Q000379:methods; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D014481:United States