title: Preoperative MRSA Screening in Pediatric Spine Surgery: A Helpful Tool or a Waste of Time and Money?
abstract: To review the use of preoperative screening for Staphylococcus aureus for all pediatric spine procedures that was instituted at our facility in a multimodal approach to decrease the frequency of postoperative wound infections.
  
  
  
  Four years ago at our facility, a multimodal approach to decrease the frequency of postoperative infections after pediatric spine surgery was instituted.
  
  
  
  A single-center, single-surgeon pediatric spine surgery database was queried to identify all patients who had preoperative S. aureus nasal swab screening. Data collected included demographic data, diagnoses, methicillin-resistant S. aureus (MRSA) swab findings, bacterial antibiotic sensitivities, and outcome of the spine surgery.
  
  
  
  A total of 339 MRSA screenings were performed. Twenty (5.9%) were MRSA positive, and 55 (16.2%) were methicillin-sensitive S. aureus (MSSA) positive. In the MRSA-positive group, 13 were neuromuscular, 5 were adolescent idiopathic scoliosis (AIS), 1 congenital, and 1 infantile idiopathic scoliosis. Of the MRSA-positive screenings, 13 (65.0% of MRSA-positive screenings; 3.8% of entire cohort) of were newly identified cases (9 neuromuscular, 3 AIS, and 1 congenital diagnoses). In the 55 MSSA-positive, 6 documented resistance to either cefazolin or clindamycin. Hence, in up to 22 of the preoperative screenings (6.5% of entire cohort; 16 MRSA and 6 MSSA showed antibiotic resistance), the preoperative antibiotic regimen could be altered to appropriately cover the identified bacterial resistances. During the study period, there were 11 patients who were diagnosed with a postoperative deep wound infection, none of them having positive screenings.
  
  
  
  The use of preoperative nasal swab MRSA screening permitted adjustment of the preoperative antibiotic regimen in up to 6.5% of patients undergoing pediatric spine surgery. This inexpensive, noninvasive tool can be used in preoperative surgical planning for all patients undergoing spinal procedures.
  
  
  
  Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA; St. Louis Children's Hospital, 1 Children's Place, St. Louis, MO 63110, USA; St. Louis Shriners Hospital, 4400 Clayton Ave, St. Louis, MO 63110, USA. Electronic address: LuhmannS@wustl.edu.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Luhmann
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA.
authors.forename: June C
authors.initials: JC
authors.lastname: Smith
mesh_terms: D002648:Child; D006801:Humans; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D009296:Nasal Cavity / Q000382:microbiology*; D011300:Preoperative Care / Q000191:economics; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis*; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection
keywords: AIS; MRSA; Nasal culture; Preoperative screening; Spine surgery