title: Methicillin-Resistant Staphylococcus aureus Infections: A Comprehensive Review and a Plastic Surgeon's Approach to the Occult Sites.
abstract: BACKGROUND
  Up to 20 percent of the general population is persistently colonized with Staphylococcus aureus, and 1 to 3 percent of the population is colonized with community-acquired methicillin-resistant S. aureus. Currently, the knowledge of methicillin-resistant Staphylococcus aureus carriage sites other than the nose, and their effect on surgical site infections in cosmetic surgery, is lacking.
  
  
  METHODS
  A comprehensive literature review using the PubMed database to analyze prevalence, anatomical carrier sites, current screening and decontamination protocols and guidelines, and methicillin-resistant S. aureus in cosmetic surgery was performed. The senior author's (L.R.) methicillin-resistant S. aureus infection experience and prevention protocols were also reviewed.
  
  
  RESULTS
  Nasal swabs detect only 50.5 percent of methicillin-resistant S. aureus colonization, and broad screening has noted the presence of methicillin-resistant S. aureus in the ear canal and umbilicus. Decolonization protocols within the orthopedic and cardiothoracic surgery literature have reduced rates of methicillin-resistant S. aureus surgical-site infections. There are no decolonization guidelines for plastic surgeons. Since instituting their decolonization protocol, the authors have had no cases of methicillin-resistant S. aureus infection in nearly 1000 cosmetic surgery procedures.
  
  
  CONCLUSIONS
  There are very limited, if any, Level I or II data regarding methicillin-resistant S. aureus screening and decolonization. As the sequelae of a surgical-site infection can be disastrous, expert opinions recommend that plastic surgeons vigorously address methicillin-resistant S. aureus colonization and infection. The authors have developed and recommend a simple decolonization protocol that includes treatment of the umbilicus, ear canal, and nares to limit surgical-site infection and improve surgical outcomes.
authors.affiliation: Palo Alto, Burlingame, and Hillsborough, Calif.|From the Division of Plastic Surgery, Stanford University Medical Center; Peninsula Plastic Surgery Center; and Crystal Springs Uplands School.
authors.forename: Cedric
authors.initials: C
authors.lastname: Hunter
authors.affiliation: Palo Alto, Burlingame, and Hillsborough, Calif.|From the Division of Plastic Surgery, Stanford University Medical Center; Peninsula Plastic Surgery Center; and Crystal Springs Uplands School.
authors.forename: Lorne
authors.initials: L
authors.lastname: Rosenfield
authors.affiliation: Palo Alto, Burlingame, and Hillsborough, Calif.|From the Division of Plastic Surgery, Stanford University Medical Center; Peninsula Plastic Surgery Center; and Crystal Springs Uplands School.
authors.forename: Elena
authors.initials: E
authors.lastname: Silverstein
authors.affiliation: Palo Alto, Burlingame, and Hillsborough, Calif.|From the Division of Plastic Surgery, Stanford University Medical Center; Peninsula Plastic Surgery Center; and Crystal Springs Uplands School.
authors.forename: Panayiota
authors.initials: P
authors.lastname: Petrou-Zeniou
mesh_terms: D014943:Global Health; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015995:Prevalence; D019651:Plastic Surgery Procedures; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control