Preoperative Staphylococcus Aureus Screening and Targeted Decolonization in Cardiac Surgery

Manoj K. Saraswat, Jonathan T. Magruder, Todd C. Crawford, Julia M. Gardner, Damon Duquaine, Marc S Sussman, Lisa Maragakis, Glenn Whitman

Research output: Contribution to journalArticle

Abstract

Background: We assessed the impact of preoperative Staphylococcus aureus screening and targeted decolonization on the incidence of postoperative methicillin-resistant S aureus (MRSA) colonization, intensive care unit MRSA transmission, and surgical site infections in cardiac surgery patients. Methods: We reviewed medical records for all adult patients during two periods: preintervention (January 2007 to April 2010) and intervention (January 2011 to December 2014). In the intervention period, we performed nasal screening for methicillin-sensitive S aureus and MRSA using polymerase chain reaction within 30 days of the operation. Colonized patients received intranasal mupirocin twice daily and chlorhexidine baths daily for 5 days; patients colonized with MRSA also received prophylactic vancomycin plus cefazolin with contact isolation precautions. Nasal surveillance for MRSA was performed on intensive care unit admission and weekly thereafter. Multivariable logistic regression models were constructed to determine risk factors for postoperative MRSA colonization, and surgical site infections and the impact of our screening program was assessed in these models. Poisson regression was used to assess MRSA transmission. Results: Comparing 2,826 preintervention and 4,038 intervention patients, cases differed in age, diabetes mellitus, preoperative infection, preoperative length of stay, and bypass time (all p ≤ 0.03). Intervention patients had risk-adjusted reductions in MRSA colonization (odds ratio 0.53, 95% confidence interval [CI]: 0.37 to 0.76, p < 0.001), transmission (incidence rate ratio 0.29, 95% CI: 0.13 to 0.65, p = 0.002), and surgical site infections (odds ratio 0.58, 95% CI: 0.40 to 0.86, p = 0.007). Increased duration of preoperative decolonization therapy was associated with decreased postoperative MRSA colonization (odds ratio 0.73, 95% CI: 0.53 to 1.00, p = 0.05). Conclusions: Preoperative S aureus screening with targeted decolonization was associated with reduced MRSA colonization, transmission, and surgical site infections. Duration of preoperative therapy correlated with decreased frequency of postoperative MRSA colonization.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2017

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Methicillin Resistance
Thoracic Surgery
Staphylococcus aureus
Surgical Wound Infection
Confidence Intervals
Odds Ratio
Nose
Intensive Care Units
Logistic Models
Mupirocin
Cefazolin
Methicillin
Chlorhexidine
Incidence
Risk Reduction Behavior
Vancomycin
Baths
Medical Records
Length of Stay
Diabetes Mellitus

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Preoperative Staphylococcus Aureus Screening and Targeted Decolonization in Cardiac Surgery. / Saraswat, Manoj K.; Magruder, Jonathan T.; Crawford, Todd C.; Gardner, Julia M.; Duquaine, Damon; Sussman, Marc S; Maragakis, Lisa; Whitman, Glenn.

In: Annals of Thoracic Surgery, 2017.

Research output: Contribution to journalArticle

Saraswat, Manoj K. ; Magruder, Jonathan T. ; Crawford, Todd C. ; Gardner, Julia M. ; Duquaine, Damon ; Sussman, Marc S ; Maragakis, Lisa ; Whitman, Glenn. / Preoperative Staphylococcus Aureus Screening and Targeted Decolonization in Cardiac Surgery. In: Annals of Thoracic Surgery. 2017.
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abstract = "Background: We assessed the impact of preoperative Staphylococcus aureus screening and targeted decolonization on the incidence of postoperative methicillin-resistant S aureus (MRSA) colonization, intensive care unit MRSA transmission, and surgical site infections in cardiac surgery patients. Methods: We reviewed medical records for all adult patients during two periods: preintervention (January 2007 to April 2010) and intervention (January 2011 to December 2014). In the intervention period, we performed nasal screening for methicillin-sensitive S aureus and MRSA using polymerase chain reaction within 30 days of the operation. Colonized patients received intranasal mupirocin twice daily and chlorhexidine baths daily for 5 days; patients colonized with MRSA also received prophylactic vancomycin plus cefazolin with contact isolation precautions. Nasal surveillance for MRSA was performed on intensive care unit admission and weekly thereafter. Multivariable logistic regression models were constructed to determine risk factors for postoperative MRSA colonization, and surgical site infections and the impact of our screening program was assessed in these models. Poisson regression was used to assess MRSA transmission. Results: Comparing 2,826 preintervention and 4,038 intervention patients, cases differed in age, diabetes mellitus, preoperative infection, preoperative length of stay, and bypass time (all p ≤ 0.03). Intervention patients had risk-adjusted reductions in MRSA colonization (odds ratio 0.53, 95{\%} confidence interval [CI]: 0.37 to 0.76, p < 0.001), transmission (incidence rate ratio 0.29, 95{\%} CI: 0.13 to 0.65, p = 0.002), and surgical site infections (odds ratio 0.58, 95{\%} CI: 0.40 to 0.86, p = 0.007). Increased duration of preoperative decolonization therapy was associated with decreased postoperative MRSA colonization (odds ratio 0.73, 95{\%} CI: 0.53 to 1.00, p = 0.05). Conclusions: Preoperative S aureus screening with targeted decolonization was associated with reduced MRSA colonization, transmission, and surgical site infections. Duration of preoperative therapy correlated with decreased frequency of postoperative MRSA colonization.",
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AU - Crawford, Todd C.

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AU - Duquaine, Damon

AU - Sussman, Marc S

AU - Maragakis, Lisa

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