title: Staphylococcus aureus and surgical site infections: benefits of screening and decolonization before surgery.
abstract: Surgical site infections (SSIs) are among the most common healthcare-associated infections, and contribute significantly to patient morbidity and healthcare costs. Staphylococcus aureus is the most common microbial cause. The epidemiology of S. aureus is changing with the dissemination of newer clones and the emergence of mupirocin resistance. The prevention and control of SSIs is multi-modal, and this article reviews the evidence on the value of screening for nasal carriage of S. aureus and subsequent decolonization of positive patients pre-operatively. Pre-operative screening, using culture- or molecular-based methods, and subsequent decolonization of patients who are positive for meticillin-susceptible S. aureus and meticillin-resistant S. aureus (MRSA) reduces SSIs and hospital stay. This applies especially to major clean surgery, such as cardiothoracic and orthopaedic, involving the insertion of implanted devices. However, it requires a multi-disciplinary approach coupled with patient education. Universal decolonization pre-operatively without screening for S. aureus may compromise the capacity to monitor for the emergence of new clones of S. aureus, contribute to mupirocin resistance, and prevent the adjustment of surgical prophylaxis for MRSA (i.e. replacement of a beta-lactam agent with a glycopeptide or alternative).
authors.affiliation: Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland. Electronic address: hhumphreys@rcsi.ie.
authors.forename: H
authors.initials: H
authors.lastname: Humphreys
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Becker
authors.affiliation: Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
authors.forename: P M
authors.initials: PM
authors.lastname: Dohmen
authors.affiliation: Clinical and Research Department, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Petrosillo
authors.affiliation: Department of Quality and Patient Safety, Universal Health Services, King of Prussia, Pennsylvania, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Spencer
authors.affiliation: Laboratory of Microbiology and Infection Control, Breda, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Rijen
authors.affiliation: Department of Antibiotics and Infection Control, Rudolfstiftung Hospital, Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Wechsler-Fördös
authors.affiliation: Infectious Disease Service, Bellvitge University Hospital, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pujol
authors.affiliation: Microbiology Department, Clinique de L'Union, Saint Jean, France.
authors.forename: A
authors.initials: A
authors.lastname: Dubouix
authors.affiliation: Department of Medicine, Mutua de Terassa University Hospital, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Garau
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Decolonization; MRSA; Screening; Staphylococcus aureus; Surgical site infection prevention