Nasal MRSA colonization: Impact on surgical site infection following spine surgery

Thakkar, Vismay; Ghobrial, George M.; Maulucci, Christopher M.; Singhal, Saurabh; Prasad, Srinivas; Harrop, James S.; Vaccaro, Alexander R.; Behrend, Caleb; Sharan, Ashwini; Jallo, Jack

doi:10.1016/j.clineuro.2014.07.018

Cited by 48 publications

(48 citation statements)

References 26 publications

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“…A total of 39 studies evaluating S. aureus SSI rates among patients who underwent spine operations of interest were included in this study (Table 1A) [6,7,10–15,32,37,45,47,48,52,53,62,77,84,90,91,101,103,111–113,117,122,126,129,132,137,138,140,146,155,160,164,167,173]. The pooled average S. aureus SSI rate was calculated to be 1% (median, 2%; range, 0.02%–10%) based on 42 cohorts evaluating a total of 112,135 patients.…”

Section: Resultsmentioning

confidence: 99%

“…According to 13 studies consisting of 14 cohorts with a total of 14,835 patients who underwent instrumented spinal fusion, the calculated pooled average rate was 1.4% (median, 2%; range, 0.1%–10%) [6,37,48,77,84,90,101,112,122,126,132,137,160]. The pooled average contribution of S. aureus infections to spinal SSIs was calculated to be 49.3% (median, 50%; range, 16.7%–100%; 2,272 SSIs) [6,7,10–15,32,37,45,47,48,52,53,62,77,84,90,91,101,103,111–113,117,122,126,129,132,137,138,140,146,155,160,164,167,173]. …”

Section: Resultsmentioning

confidence: 99%

“…There were 30 studies that assessed the proportion of S. aureus SSIs after spine operations of interest that were attributed to MRSA (Table 1B) [6,10–14,22,25,32,37,45,53,62,84,90,111,113,117,122,126,129,137,138,146,155,160,164,167,175,176]. The pooled average proportion of S. aureus SSIs attributable to MRSA was calculated to be 37.9% based on 32 cohorts with a total of 1,071 patients experiencing S. aureus SSIs (median, 42.5%).…”

Section: Resultsmentioning

confidence: 99%

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Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%–22.6%) and 1.0% (median, 2.0%; range, 0.02%–10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%–100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%–100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%–2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%–100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.Conclusions: Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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show abstract

“…This was done, as evidence exist, which suggest that MRSA positive swabs (''colonization'') either at screening or during hospitalization significantly increase the risk of subsequent MRSA infections (especially surgical site infections) [27][28][29][30][31]. Further, a clear distinction between MRSA colonization and infection can often not be routinely made due to many patients having multiple positive cultures with multiple different organisms simultaneously, thus often requiring the resulting anti-microbiological treatment to cover a whole array of bacterial spectra.…”

Section: Study Design and Setting Patient Population And Mrsa Acquismentioning

confidence: 99%

Risk factors for, and the effect of MRSA colonization on the clinical outcomes of severely burnt patients

Issler‐Fisher

McKew

Fisher

et al. 2015

Burns

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“…These include preoperative screening for nasal methicillin-resistant Staphylococcus aureus and decolonization using topical antibiotics and preadmission showering with chlorhexidine. [27,28] Prophylactic antibiotic administration is also standard practice. Nevertheless, the incidence of SSI following spine surgery ranges from 0.7% to 14%.…”

Section: Surgical Site Infectionmentioning

confidence: 99%

Nursing care of the patient undergoing lumbar spinal fusion

Lall

2017

JNEP

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Lumbar spinal fusion is a surgical procedure performed to join-or fuse-2 or more vertebrae in the low back. The procedure is done to stabilize the spine and prevent damage to the cauda equina and emanating nerve roots. Lumbar fusion is commonly indicated for patients with vertebral fractures, infection, or spinal tumors, and it may be appropriate for select patients with degenerative disorders and spinal stenosis. Nurses who care for patients undergoing lumbar fusion require an understanding of lumbar spinal anatomy, spinal pathology, surgical indications, and diagnostic modalities. Knowledge of the distinct surgical approaches and their respective advantages and disadvantages allows nurses to individualize patient care and be alert to postoperative complications. This article reviews clinical and research literature regarding lumbar fusion, with an emphasis on the role of the nurse in promoting a safe perioperative course.

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Nasal MRSA colonization: Impact on surgical site infection following spine surgery

Cited by 48 publications

References 26 publications

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Risk factors for, and the effect of MRSA colonization on the clinical outcomes of severely burnt patients

Nursing care of the patient undergoing lumbar spinal fusion

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