Staphylococcus aureus and surgical site infections: benefits of screening and decolonization before surgery

Humphreys, Hilary; Becker, Karsten; Dohmen, Pascal M.; Petrosillo, Nicola; Spencer, Maureen; Rijen, Miranda van; Wechsler-Fördös, Agnes; Pujol, Miquel; Dubouix, Anne; Garau, Javier

doi:10.1016/j.jhin.2016.06.011

Cited by 87 publications

(81 citation statements)

References 93 publications

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“…Specifically, this requirement refers to a smear test in patients with risk factors who are about to undergo surgery. Several studies have proven that MRSA screening and subsequent decolonization of MRSA-positive patients prior to surgery reduces the number of postoperative wound infections and leads to cost savings [13, 14]. …”

Section: Discussionmentioning

confidence: 99%

Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis

Hutzschenreuter

Fleßa

Dittmann

et al. 2018

Antimicrob Resist Infect Control

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BackgroundNosocomial infections are among the most common complications in hospitals. A major part is caused by multidrug-resistant organisms (MDRO). MRSA is still the most prominent and frequent MDRO. The early detection of carriers of multidrug-resistant bacteria is an effective measure to reduce nosocomial infections caused by MDRO. For patients who are planning to go to the hospital, an outpatient screening for MDRO and pre-hospital decolonization is recommended. However, the effectiveness of such pre-admission MDRO management in preparation for a planned hospital stay has not yet been sufficiently scientifically examined from an economic perspective.MethodsA decision tree will be used to develop scenarios for MDRO screening and treatment in the context of the outpatient and inpatient sectors using MRSA-positive patients as an example. Subsequently, the expected costs for the respective strategy are presented.ResultsThe decision tree analysis shows that the expected costs of outpatient MRSA management are €8.24 and that of inpatient MRSA management are €672.51.ConclusionThe forward displacement of the MRSA screening to the ambulatory sector and any subsequent outpatient decolonization for patients with a planned hospitalization is the most cost-effective strategy and should become a standard benefit. Excluding opportunity costs, the expected costs of inpatient MRSA management are €54.94.

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Section: Discussionmentioning

confidence: 99%

Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis

Hutzschenreuter

Fleßa

Dittmann

et al. 2018

Antimicrob Resist Infect Control

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“…Decolonization treatment can reduce infections originating from SANC: targeted decolonization reduces surgical site infection; non-targeted decolonization reduces all bacteraemias in an ICU setting, and in the following year outside the ICU 15, 26, 27. Outside of the ICU, non-targeted use of antibiotics is unlikely to be supported amid increasing recognition of the impact of antimicrobial resistance 18 . Our study raises the possibility of patient self-swabbing for effective and resource-efficient pre-admission screening for SANC and targeted preoperative decolonization.…”

Section: Discussionmentioning

confidence: 99%

“…Infection prevention strategies such as decolonization successfully reduce the incidence of postoperative infection in carriers, and screening allows the targeting of these interventions and reduced antimicrobial use 15, 16. Screening with targeted decolonization has been integrated into some postoperative infection prevention guidelines, but the design of programmes for screening and targeted decolonization remains an unsolved challenge 17, 18…”

Section: Introductionmentioning

confidence: 99%

Multi-site and nasal swabbing for carriage of Staphylococcus aureus : what does a single nose swab predict?

Young

Votintseva

Foster

et al. 2017

Journal of Hospital Infection

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SummaryBackgroundCarriage of Staphylococcus aureus is a risk for infections. Targeted decolonization reduces postoperative infections but depends on accurate screening.AimTo compare detection of S. aureus carriage in healthy individuals between anatomical sites and nurse- versus self-swabbing; also to determine whether a single nasal swab predicted carriage over four weeks.MethodsHealthy individuals were recruited via general practices. After consent, nurses performed multi-site swabbing (nose, throat, and axilla). Participants performed nasal swabbing twice-weekly for four weeks. Swabs were returned by mail and cultured for S. aureus. All S. aureus isolates underwent spa typing. Persistent carriage in individuals returning more than three self-swabs was defined as culture of S. aureus from all or all but one self-swabs.FindingsIn all, 102 individuals underwent multi-site swabbing; S. aureus carriage was detected from at least one site from 40 individuals (39%). There was no difference between nose (29/102, 28%) and throat (28/102, 27%) isolation rates: the combination increased total detection rate by 10%. Ninety-nine patients returned any self-swab, and 96 returned more than three. Nasal carriage detection was not significantly different on nurse or self-swab [28/99 (74%) vs 26/99 (72%); χ2: P = 0.75]. Twenty-two out of 25 participants with first self-swab positive were persistent carriers and 69/71 with first self-swab negative were not, giving high positive predictive value (88%), and very high negative predictive value (97%).ConclusionNasal swabs detected the majority of carriage; throat swabs increased detection by 10%. Self-taken nasal swabs were equivalent to nurse-taken swabs and predicted persistent nasal carriage over four weeks.

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“…During the pre-intervention period, the most predominant organisms cultured from sternum were MSSA and CoNS with no cases of MRSA. This could be due in part to the emergence of MRSA in the general population and the increasing bacterial resistance of Staphylococcus aureus to mupirocin during the post-intervention period (18). This is an important finding, as MRSA is associated with higher mortality rates, longer hospital length of stays, and higher hospital costs compared with other infections (19).…”

Section: Discussionmentioning

confidence: 99%

Reducing Pediatric Sternal Wound Infections: A Quality Improvement Project

Delgado-Corcoran

Dorn

Pribble

et al. 2017

Pediatric Critical Care Medicine

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Objectives To evaluate whether a quality improvement intervention reduces sternal wound infection (SWI) rates in children after cardiac surgery. Design This is a pre- and post-intervention quality improvement study. Setting A 16-bed cardiac intensive care unit in a university-affiliated pediatric tertiary care children’s hospital. Patients All patients undergoing cardiac surgery via median sternotomy from January 2010 to December 2014 are included. The SWI rates for primary closure (PC) and delayed sternal closure (DSC) are reported per 100 sternotomies. The hospital acquired infection (HAI) records were used to identify pre- intervention cases, while post-intervention cases were collected prospectively. Intervention Implementation of a sternal wound prevention bundle (SWPB) during the preoperative, intraoperative and postoperative periods for cardiac surgical cases. Measurements and Main Results During the pre-intervention period, 32 (3.8%) patients developed SWI while only 19 (2.1%) developed SWI during the post-intervention period (p=0.04). The rates of SWI following PC were not significantly different pre- and post-intervention (2.4% vs. 1.6%; p=0.35). However, patients with DSC had significantly lower post-intervention infection rates (10.6% vs. 3.9%; p=0.02). Conclusions Implementation of a SWPB during the perioperative period was associated with lower SWI rates in surgeries with DSC.

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Staphylococcus aureus and surgical site infections: benefits of screening and decolonization before surgery

Cited by 87 publications

References 93 publications

Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis

Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis

Multi-site and nasal swabbing for carriage of Staphylococcus aureus : what does a single nose swab predict?

Reducing Pediatric Sternal Wound Infections: A Quality Improvement Project

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