Evaluation of Staphylococcus aureus Eradication Therapy in Vascular Surgery

Abstract

IntroductionSurgical site infections (SSI) are a serious complication in vascular surgery which may lead to severe morbidity and mortality. Staphylococcus aureus nasal carriage is associated with increased risk for development of SSIs in central vascular surgery. The risk for SSI can be reduced by perioperative eradication of S. aureus carriage in cardiothoracic and orthopedic surgery. This study analyzes the relation between S. aureus eradication therapy and SSI in a vascular surgery population.MethodsA prospective cohort study was performed, including all patients undergoing vascular surgery between February 2013 and April 2015. Patients were screened for S. aureus nasal carriage and, when tested positive, were subsequently treated with eradication therapy. The presence of SSI was recorded based on criteria of the CDC. The control group consisted of a cohort of vascular surgery patients in 2010, who were screened, but received no treatment.ResultsA total of 444 patients were screened. 104 nasal swabs were positive for S. aureus, these patients were included in the intervention group. 204 patients were screened in the 2010 cohort. 51 tested positive and were included in the control group. The incidence of S. aureus infection was 5 out of 51 (9.8%) in the control group versus 3 out of 104 in the eradication group (2.2%; 95% confidence interval 0.02–1.39; P = 0.13). A subgroup analysis showed that the incidence of S. aureus infection was 3 out of 23 (13.0%) in the control group in central reconstructive surgery versus 0 out of 44 in the intervention group (P = 0.074). The reduction of infection pressure by S. aureus was stronger than the reduction of infection pressure by other pathogens (exact maximum likelihood estimation; OR = 0.0724; 95% CI: 0.001–0.98; p = 0.0475).ConclusionS. aureus eradication therapy reduces the infection pressure of S. aureus, resulting in a reduction of SSIs caused by S. aureus.

The Impact of Nasal Staphylococcus aureus Carriage on Surgical-Site Infections after Immediate Breast Reconstruction: Risk Factors and Biofilm Formation Potential

“…For example, in a randomized, multicenter clinical trial, Bode et al [ 32 ] found that the risk of healthcare-associated S. aureus infections was reduced by almost 60% among patients with decolonization. Similarly, Langenberg et al [ 33 ] confirmed a reduction in SSI with S. aureus decolonization among patients undergoing central vascular reconstruction surgery. The reported S. aureus SSI rate was 13.0% in the positive not-treated group, and 0.0% in the positive treated group.…”

Do Surgical Site Infections in Open Aortoiliac Surgery Differ Between Occlusive and Aneurysmal Arterial Disease?

“…Previous studies show that a reduction in S aureus -infections might be accomplished in open aortoiliac surgery by means of specific eradication therapy for nasal carriers, which was associated with a significant reduction in 1-year mortality. 19,28 Graft infection with S aureus occurs in less than 1% of aortic grafts and in 2% to 5% of inguinal grafts, with associated mortality and major amputations as high as 40%. It seems that especially in patients with aortoiliac occlusive disease, a large amount of S aureus –related mortality and morbidity can be prevented.…”

“…From February 2013 onward, a protocol for Staphylococcus aureus nasal screening was used in the research hospital. 19 Following this protocol, all patients were subjected to nasal screening before vascular surgery. Patients who tested positive for S aureus were subsequently treated with eradication therapy consisting of mupirocin ointment and chlorhexidine gluconate soap for 5 days before undergoing surgery.…”