title: Preoperative Staphylococcus aureus Carriage and Risk of Surgical Site Infection After Cardiac Surgery in Children Younger than 1 year: A Pilot Cohort Study.
abstract: Surgical site infections (SSI) increase length of stay, morbidity, mortality and cost of hospitalization. Staphylococcus aureus (SA) carriage is a known risk factor of SSI in adults, but its role in pediatrics remains uncertain. The main objective of this pilot prospective monocentric cohort study was to describe the prevalence of SA colonization in children under 1 year old before cardiac surgery. The secondary objectives were to compare the incidence of SSI and other nosocomial infections (NI) between preoperative carriers and non-carriers. From May 2012 to November 2013, all children <1 year old undergoing cardiac surgery under cardiopulmonary bypass underwent preoperative methicillin-resistant (MRSA) and methicillin-sensitive SA (MSSA) screening using real-time PCR. The only exclusion criterion was invalid PCR. All patients were followed up to 1 year after the surgery regarding SSI and other nosocomial infections. Among the 68 studied patients, SA colonization prevalence was 26.5%, comprising 23.5% MSSA and 2.9% MRSA. There was no significant difference between colonized and non-colonized children regarding SSI rate (16.7 vs 20%; p = 0.53), but ventilator-associated pneumonia rate was significantly higher among the SA carriers (22.2 vs 2%; p < 0.05). The colonization rate was different depending on the age of the patients (p < 0.05). This pilot study highlights that colonization with MSSA is frequent whereas MRSA prevalence is low in our population. In this cohort, there was no association between SA colonization and SSI incidence but further studies are needed to analyze this association.
authors.affiliation: Department of Pediatric Intensive Care, Hôpital Mère Enfant, Nantes University Hospital, Boulevard Jean Monnet, 44093, Nantes, France. julie.macher@gmail.com.
authors.forename: J
authors.identifier: http://orcid.org/0000-0003-4841-8812
authors.initials: J
authors.lastname: Macher
authors.affiliation: Department of Pediatrics, Nantes University Hospital, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Gras Le Guen
authors.affiliation: Department of Pediatric Intensive Care, Hôpital Mère Enfant, Nantes University Hospital, Boulevard Jean Monnet, 44093, Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Chenouard
authors.affiliation: Department of Pediatric Intensive Care, Hôpital Mère Enfant, Nantes University Hospital, Boulevard Jean Monnet, 44093, Nantes, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Liet
authors.affiliation: Department of Pediatric Intensive Care, Hôpital Mère Enfant, Nantes University Hospital, Boulevard Jean Monnet, 44093, Nantes, France.
authors.forename: B
authors.initials: B
authors.lastname: Gaillard Le Roux
authors.affiliation: National Institute of Health and Medical Research CIC 004, Nantes University Hospital, Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Legrand
authors.affiliation: Department of Pediatric Intensive Care, Hôpital Mère Enfant, Nantes University Hospital, Boulevard Jean Monnet, 44093, Nantes, France.
authors.forename: J
authors.initials: J
authors.lastname: Mahuet
authors.affiliation: Department of Pediatrics, Nantes University Hospital, Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Launay
authors.affiliation: Department of Pediatric Cardiology, Nantes University Hospital, Nantes, France.
authors.forename: V
authors.initials: V
authors.lastname: Gournay
authors.affiliation: Department of Pediatric Intensive Care, Hôpital Mère Enfant, Nantes University Hospital, Boulevard Jean Monnet, 44093, Nantes, France.
authors.forename: N
authors.initials: N
authors.lastname: Joram
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods; D010865:Pilot Projects; D015995:Prevalence; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000235:genetics; D013530:Surgical Wound Infection / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Nosocomial infections; Pediatric cardiac surgery; Staphylococcus aureus screening; Surgical site infection