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To evaluate the importance of nasal carriage of Staphylococcus aureus as a risk factor for the development of wound infection at the sternotomy site after cardiac surgery, a case-control study was done. The study population consisted of 1980 consecutive patients. Cases were all patients who developed a sternal wound infection from which S. aureus was cultured. Forty cases were identified, and 120 controls were selected. Preoperative nasal carriage of S. aureus, insulin-dependent diabetes mellitus, and younger age were identified as significant risk factors. The crude odds ratio of nasal carriage was 9.6 (95% confidence interval, 3.9-23.7). The median postoperative length of hospital stay for cases was 30 days longer than for controls. Mortality was also significantly higher for cases than for controls (10.0% and 0.8%, respectively).

HE SUCCESS OF THE INTRODUCtion in 2000 in the United States of routine infant vaccination with the licensed 7-valent pneumococcal conjugate vaccine (PCV-7) is based on direct protection against vaccine serotype pneumococcal disease among vaccinees but also on the observed and unexpectedly large and widespread reduction in invasive and respiratory (eg, pneumonia and otitis media) vaccine serotype pneumococcal disease in nonimmunized individuals (indirect effect or herd protection). 1-6 This herd effect has been attributed to reduced carriage of vaccine serotype pneumococci in vaccinated infants and subsequent transmission to (household) adult contacts and spread in the community. The resulting decreased circulation of the 7 serotypes and herd effects have contributed substantially to the public health benefit and costeffectiveness of PCV-7 programs. 7,8 Increasingly crowded infant vaccine schedules and less favorable cost

This study evaluated effects of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D-conjugate vaccine (PHiDCV) compared with the 7-valent vaccine on nasopharyngeal bacterial colonization, specifically nontypeable Haemophilus influenzae (NTHi). PHiD-CV had no differential effect on nasopharyngeal NTHi colonization.

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