Pre-operative methicillin resistant Staphylococcus aureus results do not predict surgical site infections in children undergoing varus derotational osteotomy

Abstract

Literature regarding the value of pre-operative nasal methicillin resistant Staphylococcus aureus (MRSA) swabs to predict surgical site infections (SSIs) in children undergoing lower extremity surgery is limited. The purpose of our study was to determine if pre-operative nasal MRSA swab results were predictive of SSI development in children undergoing a femoral varus derotational osteotomy (VDRO). Patients who underwent VDRO between 2004–2016 were reviewed to determine pre-operative MRSA colonization rates and SSI devolvement rates. Patients with less than 1 year of follow-up, previous history of infections, or absent pre-operative MRSA swab were excluded. SSI rates of patients with negative MRSA and positive MRSA swab result were compared using the Fisher exact test. Aside from contact isolation precautions, no other changes in treatment were made during inpatient hospital course based on positive pre-operative nasal MRSA swab results. 247 patients met the inclusion criteria (mean age: 9.3 ± 3.6 years, 62% male). There were 242 (98%) patients with a negative MRSA swab and 5 (2%) patients with a positive MRSA swab. Out of the 242 patients with a negative MRSA swab, 4 developed an SSI. Of the patients with positive MRSA swab results, 0% (0/5) developed an SSI compared to 1.7% (4/242) of negative MRSA swab results who developed an SSI. Results indicated no significant difference in SSI development rates between the groups (P = 1.00). In this series of children undergoing VDRO surgery, the results of a pre-operative MRSA nasal swab had no relationship to SSI incidence and no impact on clinical patient care. Pre-operative MRSA nasal swabs appear to be of limited benefit for routine pre-operative screening in this patient population. Level III, retrospective comparative

Prevalence of Staphylococcus aureus nasal carriage and surgical site infection rate among patients undergoing elective cardiac surgery

“…In the present study, the prevalence of MSSA and MRSA nasal carriage was 13.1% and 0.3%, respectively, rates that are much lower than those reported in previous studies (Herrmann et al, 2013;Kondo et al, 2020;Nazareth et al, 2020;Reid et al, 2017;Vos et al, 2009). The discrepancy may be due to differences in patient baseline characteristics.…”

“…MRSA infection has become a global problem, and these infections have been associated with worse outcomes. The reported prevalence of MRSA nasal carriage in patients undergoing surgery ranges between 1.5% and 9.4% (Herrmann et al, 2013;Kondo et al, 2020;Mizuno et al, 2019;Munoz et al, 2008;Nazareth et al, 2020;Vos et al, 2009). The prevalence of MRSA nasal carriage in Japanese patients undergoing colorectal surgery was 3.4% (Kondo et al, 2020), whereas the prevalence of MRSA nasal carriage in Spanish patients undergoing cardiac surgery was as high as 9.4% (Munoz et al, 2008).…”

“…The prevalence of MRSA nasal carriage in Japanese patients undergoing colorectal surgery was 3.4% (Kondo et al, 2020), whereas the prevalence of MRSA nasal carriage in Spanish patients undergoing cardiac surgery was as high as 9.4% (Munoz et al, 2008). There have been conflicting data regarding the association of nasal carriage of methicillinresistant strains and surgical site infection (Nazareth et al, 2020;Saraswat et al, 2017).…”

Prevalence of surgical site wound infection after spine surgery in nasal colonization of methicillin‐resistant Staphylococcus aureus: A meta‐analysis

“…The sample size was 247-356 people. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] The examined data revealed that MRSA-positive had a significantly higher SSI compared with MRSA-negative in SS subjects.…”

Preoperative Microbiological Screening in Pediatric Assessment of Skeletal Dysplasias Cases Before Planned Orthopedic Surgery

“…In a study of 247 children undergoing varus derotation osteotomy, Nazareth et al (2020) found 2% positive MRSA swab tests. The MRSA nasal swab test is routinely used as a pre-operative screening method based on the assumption that the results will influence the treatment management and decrease the surgical site infections rates [15]. To determine pre-operative MRSA colonization status, Nielsen et al (2018) presented a retrospective chart review of patients after posterior spinal fusion performed between 2004 and 2014, and identified 2.3% MRSA-positive cases [16].…”