View point: gaps in the current guidelines for the prevention of Methicillin-resistant Staphylococcus aureus surgical site infections

Abstract

The authors advocate the addition of two preventative strategies to the current United State’s guidelines for the prevention of surgical site infections. It is known that Staphylococcus aureus, including Methicillin-resistant Staphylococcus aureus (MRSA), carriers are at a higher risk for the development of infections and they can easily transmit the organism. The carriage rate of Staph. aureus in the general population approximates 33%. The CDC estimates the carriage rate of MRSA in the United States is approximately 2%. The first strategy is preoperative screening of surgical patients for Staph. aureus, including MRSA. This recommendation is based upon the growing literature which shows a benefit in both prevention of infections and guidance in preoperative antibiotic selection. The second is performing MRSA active surveillance screening on healthcare workers. The carriage rate of MRSA in healthcare workers approximates 5% and there are concerns of transmission of this pathogen to patients. MRSA decolonization of healthcare workers has been reported to approach a success rate of 90%. Healthcare workers colonized with dangerous pathogens, including MRSA, should be assigned to non-patient contact work areas. In addition, there needs to be implemented a safety net for both the worker’s economic security and healthcare. Finally, a reporting system for the healthcare worker acquisition and infections with dangerous pathogens needs to be implemented. These recommendations are needed because Staph. aureus including MRSA is endemic in the United States. Policies regarding endemic pathogens which are to be implemented only upon the occurrence of a facility defined “outbreak” have to be questioned, since absence of infections does not mean absence of transmission. Optimizing these policies will require further research but until then we should error on the side of patient safety.

<p>In Vitro Activity Of Ceftaroline And Comparators Against <em>Staphylococcus aureus</em> Isolates: Results From 6 Years Of The ATLAS Program (2012 To 2017)</p>

“…The report from the German surveillance network did not examine ceftaroline,22 but the SENTRY program reported that the susceptibility of MSSA to ceftaroline was 100% and that of MRSA was 91.6% 23. For skin and soft tissue infections with suspected MRSA, the guidelines usually recommend oral TMP-SMX, doxycycline, minocycline, and clindamycin, as well as newer agents like linezolid and tedizolid; intravenous vancomycin is the first choice for hospitalized patients, followed by daptomycin when vancomycin cannot be given 1,24–26. For bacteremia of suspected MRSA origin, vancomycin and daptomycin are the first choices, followed by ceftaroline combination regimens and teicoplanin 1,27,28.…”

Evaluation of Loop-Mediated Isothermal Amplification (LAMP) Assay in Detection of Methicillin-Resistant Staphylococcus Aureus (MRSA) among Health Care Providers in Benha University Hospitals

“…Moreover, in the USA a study reported that the carriage rate of MRSA in healthcare workers approximates 5% with concerns of transmission of this pathogen to patients (13).…”

MRSA screening and spa gene detection in isolates from healthcare workers at ophthalmology hospital in Egypt

“…Very recently in the USA, Kavanagh et al (2018) reported the carriage rate of S. aureus in the general population approximates 33% and that of MRSA is approximately 2% as estimated by the CDC; still, the carriage rate of MRSA in healthcare workers approximates 5% with concerns of transmission of this pathogen to patients. Also, these recent results reported by Kavanagh et al (2018) are lower than our results regarding S. aureus and MRSA. On the other hand, in Iran, a study was done by Shakeri et al (2010) reported the prevalence of MRSA from healthy carriers and patients as 28%.…”