Skip to main content

Advertisement

SpringerLink
Log in

Nasal MRSA screening for surgical patients: predictive value for postoperative infections caused by MRSA

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Postoperative methicillin-resistant Staphylococcus aureus (MRSA) infections are occasionally fatal. We hypothesized that nasal MRSA screening might predict the risk of postoperative MRSA infections. The aim of the current study was to elucidate the relationship between the positivity of nasal MRSA screening and postoperative MRSA infections.

Methods

Six hundred and fourteen surgical patients who were admitted to the intensive care unit and underwent nasal MRSA screening between April 2006 and March 2011 were divided into MRSA-positive and -negative groups. The incidence of postoperative MRSA infections in the MRSA-positive and MRSA-negative groups were compared, and various risk factors for MRSA infections were evaluated.

Results

The incidence of postoperative MRSA infections, such as pneumonia and enteritis, in the MRSA-positive group was significantly higher than that in the MRSA-negative group (41.9 vs. 3.1 %). The significant independent risk factors for postoperative MRSA infections were a positive MRSA screening, an operation lasting more than 300 min and an emergency operation. A positive MRSA screening was the most statistically significant risk factor for postoperative MRSA pneumonia and enteritis, but was not a risk factor for MRSA surgical site infections.

Conclusion

Nasal MRSA screening can help to identify patients who have an increased risk of developing postoperative MRSA infections, and would enable physicians to take a prompt action if these complications occur.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kusachi S, Nagao J, Saida Y, Watanabe M, Nakamura Y, Asai K, et al. Twenty years of countermeasures against postoperative methicillin-resistant Staphylococcus aureus infections. Surg Today. 2011;41:630–6.

    Article  PubMed  Google Scholar 

  2. Jain R, Kralovic SM, Evans ME, Ambrose M, Simbartl LA, Obrosky S, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med. 2011;364:1419–30.

    Article  CAS  PubMed  Google Scholar 

  3. Jernigan JA, Clemence MA, Stott GA, Titus MG, Alexander CH, Palumbo CM, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol. 1995;16:686–96.

    Article  CAS  PubMed  Google Scholar 

  4. Harbarth S, Fankhauser C, Schrenzel J, Christenson J, Gervaz P, Bandiera-Clerc C, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA. 2008;299:1149–57.

    Article  CAS  PubMed  Google Scholar 

  5. Anderson DJ, Sexton DJ, Kanafani ZA, Auten G, Kaye KS. Severe surgical site infection in community hospitals: epidemiology, key procedures and the changing prevalence of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2007;28:1047–53.

    Article  PubMed  Google Scholar 

  6. Awad SS, Palacio CH, Subramanian A, Byers PA, Abraham P, Lewis DA, et al. Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) prevention bundle results in decreased MRSA surgical site infections. Am J Surg. 2009;198:607–10.

    Article  PubMed  Google Scholar 

  7. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for disease control and prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control. 1999;27:97–134.

    Article  CAS  PubMed  Google Scholar 

  8. Manian FA, Meyer PL, Setzer J, Senkel D. Surgical site infections associated with methicillin-resistant Staphylococcus aureus: do postoperative factors play a role? Clin Infect Dis. 2003;36:863–8.

    Article  PubMed  Google Scholar 

  9. Kodama T, Santo T, Yokoyama T, Takesue Y, Hiyama E, Imamura Y, et al. Postoperative enteritis caused by methicillin-resistant Staphylococcus aureus. Surg Today. 1997;27:816–25.

    Article  CAS  PubMed  Google Scholar 

  10. Murphy GJ, Pararajasingam R, Nasim A, Dennis MJ, Sayers RD. Methicillin-resistant Staphylococcus aureus infection in vascular surgical patients. Ann R Coll Surg Engl. 2001;83:158–63.

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Tanaka H, Miyazaki S, Sumiyama Y, Kakiuchi T. Role of macrophages in a mouse model of postoperative MRSA enteritis. J Surg Res. 2004;118:114–21.

    Article  CAS  PubMed  Google Scholar 

  12. Anderson DJ, Kaye KS, Chen LF, Schmader KE, Choi Y, Sloane R, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS ONE. 2009;4:e8305.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Wernitz MH, Keck S, Swidsinski S, Schulz S, Veit SK. Cost analysis of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment. Clin Microbiol Infect. 2005;11:466–71.

    Article  CAS  PubMed  Google Scholar 

  14. Cimochowski GE, Harostock MD, Brown R, Bernardi M, Alonzo N, Coyle K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg. 2001;71:1572–9.

    Article  CAS  PubMed  Google Scholar 

  15. Gavalda L, Masuet C, Beltran J, Garcia M, Garcia D, Sirvent JM, et al. Comparative cost of selective screening to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA), compared with the attributable costs of MRSA infection. Infect Control Hosp Epidemiol. 2006;27:1264–6.

    Article  PubMed  Google Scholar 

  16. Mermel LA, Cartony JM, Covington P, Maxey G, Morse D. Methicillin-resistant Staphylococcus aureus (MRSA) colonization at different body sites: a prospective, quantitative analysis. J Clin Microbiol. 2011;49:1119–21.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Papia G, Louie M, Tralla A, Johnson C, Collins V, Simor AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol. 1999;20:473–7.

    Article  CAS  PubMed  Google Scholar 

  18. Felten A, Grandry B, Lagrange PH, Casin I. Evaluation of three techniques for detection of low-level methicillin-resistant Staphylococcus aureus (MRSA): a disk diffusion method with cefoxitin and moxalactam, the vitek 2 system, and the MRSA-screen latex agglutination test. J Clin Microbiol. 2002;40:2766–71.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Flayhart D, Hindler JF, Bruckner DA, Hall G, Shrestha RK, Vogel SA, et al. Multicenter evaluation of BBL CHROM- agar MRSA medium for direct detection of methicillin-resistant Staphylococcus aureus from surveillance cultures of the anterior nares. J Clin Microbiol. 2005;43:5536–40.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Wikler MA, Cockerill FR, Craig WA, Dudley MN, Eliopoulos GM, Hecht DW, et al. Performance standards for antimicrobial susceptibility testing; 17th informational supplement. Clinical Laboratory Standards Institute (CLSI) document M100-S17. Wayne Pennsylvania: CLSI; 2007. p. 44–51, p. 110–15.

  21. Akobeng AK. Understanding diagnostic test 3: receiver operating characteristic curves. Acta Paediatr. 2007;96:644–7.

    Article  PubMed  Google Scholar 

  22. Rezende NA, Blumberg HM, Metzger BS, Larsen NM, Ray SM, McGowan JE Jr. Risk factors for methicillin resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission. Am J Med Sci. 2002;323:117–23.

    Article  PubMed  Google Scholar 

  23. Coello R, Glynn JR, Graspar C, Picazo JJ, Fereres J. Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized with MRSA. J Hosp Infect. 1997;37:39–46.

    Article  CAS  PubMed  Google Scholar 

  24. Garvin KL, Konigsberg BS. Infection following total knee arthroplasty prevention and management. J Bone Jt Surg. 2011;93:1167–75.

    Google Scholar 

  25. Lodise TP, McKinnon PS, Swiderski L, Rybak MJ. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis. 2003;36:1418–23.

    Article  PubMed  Google Scholar 

  26. Bartlett JG. Antibiotic-associated diarrhea. Clin Infect Dis. 1992;15:573–81.

    Article  CAS  PubMed  Google Scholar 

  27. Kyne L, Sougioultzis S, McFarland LV, Kelly CP. Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol. 2002;23:653–9.

    Article  PubMed  Google Scholar 

  28. Meyer E, Gastmeier P, Weizel-Kage D, Charite SF. Associations between nosocomial meticillin-resistant Staphylococcus aureus and nosocomial Clostridium difficile-associated diarrhoea in 89 German hospitals. J Hosp Infect. 2012;82:181–6.

    Article  CAS  PubMed  Google Scholar 

  29. Kohno S, Watanabe A, Matsushima T, HAP Study Group. Nationwide multicenter survey on the pathophysiology of hospital-acquired pneumonia and the use of first-line antibiotics in Japan: Evaluation of clinical position of meropenem in the initial therapy of hospital-acquired pneumonia. Jpn J Chemother. 2006;54:453–64 (Japanese).

    Google Scholar 

  30. Sakamoto H, Fukuda I, Oosaka M, Nakata H. Risk factors and treatment of deep sternal wound infection after cardiac operation. Ann Thorac Cardiovasc Surg. 2003;9:226–32.

    PubMed  Google Scholar 

  31. Gernaat-van der Sluis AJ, Hoogenboom-Verdegaal AM, Edixhoven PJ, Spies-van Rooijen NH. Prophylactic mupirocin could reduce orthopedic wound infections. 1,044 patients treated with mupirocin compared with 1,260 historical controls. Acta Orthop Scand. 1998;69:412–4.

    Article  CAS  PubMed  Google Scholar 

  32. Kalmeijer MD, Coertjens H, van Nieuwland-Bollen PM, Bogaers-Hofman D, de Baere GA, Stuurman A, et al. Surgical site infection in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis. 2002;35:353–8.

    Article  CAS  PubMed  Google Scholar 

  33. Khan OA, Weston VC, Scammell BE. Methicillin-resistant Staphylococcus aureus incidence and outcome in patients with neck of femur fractures. J Hosp Infect. 2002;51:185–8.

    Article  CAS  PubMed  Google Scholar 

  34. Kluytmans JA, Mouton JW, VandenBergh MF, Manders MJ, Maat AP, Wagenvoort JH, et al. Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol. 1996;17:780–5.

    Article  CAS  PubMed  Google Scholar 

  35. Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002;24:1871–7.

    Article  Google Scholar 

  36. Kuda T, Tateyama M, Saito A, Kuniyoshi Y, Koja K. Role of mupirocin in cases of cardiovascular surgery. Jpn Environ Infect. 2003;18:232–4 (Japanese).

    Google Scholar 

  37. Suzuki R, Uchida J, Azumi C, Aono H, Nanba T, Takeda A. Preoperative decolonization of methicillin resistant Staphylococcus aureus prevents postoperative nosocomial MRSA infection in patients scheduled for major surgeries. Jpn ICU CCU. 2005;29:553–6 (Japanese).

    Google Scholar 

  38. Hida K, Yamaguchi T, Hata H, Kuroyanagi H, Nagayama S, Tada H, et al. Risk factors for complications after laparoscopic surgery in colorectal cancer patients: experience of 401 cases at a single institution. World J Surg. 2009;33:1733–40.

    Article  PubMed  Google Scholar 

  39. Murtaza B, Saeed S, Sharif MA. Postoperative complications in emergency versus elective laparotomies at a peripheral hospital. J Ayub Med Coll Abbottabad. 2010;22:42–7.

    PubMed  Google Scholar 

  40. Ngian KS, Nambiar R. Major surgery in the elderly: a study of outcome in 295 consecutive cases. Sing Med J. 1989;30:339–42.

    CAS  Google Scholar 

  41. Yano K, Minoda Y, Sakawa A, Kuwano Y, Kondo K, Fukushima W, et al. Positive nasal culture of methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for surgical site infection in orthopedics. Acta Orthop. 2009;80:486–90.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Goyal N, Miller A, Tripathi M, Parvizi J. Methicillin-resistant Staphylococcus aureus (MRSA): colonisation and pre-operative screening. Bone Jt J. 2013;95:4–9.

    Article  Google Scholar 

  43. Thannni LO, Aigoro NO. Surgical site infection complicating internal fixation of fractures: incidence and risk factors. J Natl Med Assoc. 2004;96:1070–2.

    Google Scholar 

  44. Ramirez MC, Marchessault M, Govednik-Horny C, Jupiter D, Papaconstantinou HT. The impact of MRSA colonization on surgical site infection following major gastrointestinal surgery. J Gastrointest Surg. 2013;17:144–52.

    Article  PubMed  Google Scholar 

  45. Dineen P, Drusin L. Epidemics of postoperative wound infections associated with hair carriers. Lancet. 1973;2:1157–9.

    Article  CAS  PubMed  Google Scholar 

  46. Hardin WD, Nichols RL. Aseptic technique in the operating room. In: Fry DE, editor. Surgical infections. Boston: Little, Brown and Co; 1995. p. 109–18.

    Google Scholar 

  47. Tunevall TG, Jarbeck H. Influence of wearing masks on the density of airborne bacteria in the vicinity of the surgical wound. Eur J Surg. 1992;158:263–6.

    CAS  PubMed  Google Scholar 

  48. Morikoshi E, Satou N, Mukai S, Saitou M, Tamegai Y. Clinical studies of postoperative MRSA infectious disease. With special reference to the cause and countermeasures. Jpn J Clin Surg. 1992;53:1507–15 (Japanese).

    Google Scholar 

  49. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003;24:362–86.

    Article  PubMed  Google Scholar 

  50. Pofahl WE, Ramsey KM, Nobles DL, Cochran MK, Goettler C. Importance of methicillin-resistant Staphylococcus aureus eradication in carriers to prevent postoperative methicillin-resistant Staphylococcus aureus surgical site infection. Am Surg. 2011;77:27–31.

    PubMed  Google Scholar 

  51. Pofahl WE, Goettler CE, Ramsey KM, Cochran MK, Nobles DL, Rotondo MF. Active surveillance screening of MRSA and eradication of the carrier state decreases surgical-site infections caused by MRSA. J Am Coll Surg. 2009;208:981–6.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest with regard to the contents of this manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery, Fukuoka City Hospital, Fukuoka, 812-0046, Japan

    Yutaka Matsubara, Hideaki Uchiyama, Takahiro Higashi, Ai Edagawa, Hirokuni Ishii, Shigeyuki Nagata, Kenkichi Hashimoto, Daihiko Eguchi, Hirofumi Kawanaka, Toshirou Okuyama, Masahiro Tateishi, Daisuke Korenaga & Kenji Takenaka

Authors
  1. Yutaka Matsubara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hideaki Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takahiro Higashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ai Edagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hirokuni Ishii
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shigeyuki Nagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kenkichi Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daihiko Eguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hirofumi Kawanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Toshirou Okuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masahiro Tateishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Daisuke Korenaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kenji Takenaka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yutaka Matsubara.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matsubara, Y., Uchiyama, H., Higashi, T. et al. Nasal MRSA screening for surgical patients: predictive value for postoperative infections caused by MRSA. Surg Today 44, 1018–1025 (2014). https://doi.org/10.1007/s00595-013-0648-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0648-8

Keywords

Search

Navigation