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Prediction of surgical site infection in spine surgery from tests of nasal MRSA colonization and drain tip culture

  • Original Article • SPINE - INFECTION
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

MRSA is an organism that is a possible risk factor for postoperative SSI. The purpose of the study was to examine relationships among surgical site infection (SSI) after spinal surgery, nasal methicillin-resistant staphylococcus aureus (MRSA) colonization, and wound drain culture results.

Methods

The subjects were 132 patients who underwent spinal instrumentation surgery. A preoperative nasal swab was used to check for the presence of MRSA colonization, and a wound drain tip culture was performed for detection of SSI. Data from culture studies using nasal samples and those from the distal tip of the wound drain were used for analysis.

Results

Five patients (3.8%) had nasal MRSA, 17 (13%) had positive drain tip cultures, 15 (11%) had SSIs, and 10 (8%) had SSIs with MRSA. Patients with nasal MRSA had a higher rate of detection of bacteria in the drain tip culture (40 vs. 19%, p = 0.065), and the SSI rate was significantly higher in patients with a positive drain tip culture (33 vs. 10%, p = 0.012). The total SSI rate differed significantly between patients with and without nasal MRSA (40 vs. 10%, p = 0.039); however, the SSI with MRSA rate did not differ significantly between these groups.

Conclusion

MRSA carriers were not necessarily associated with MRSA infection, but were related to a positive drain tip culture and SSI, which might be due to endogenous skin bacteria. Therefore, possible SSI should be considered in patients with nasal MRSA colonization or bacteria detected in a drain tip culture.

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References

  1. Wertheim HF, Melles DC, Vos MC et al (2005) The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 5:751–762

    Article  PubMed  Google Scholar 

  2. Bode LG, Kluytmans JA, Wertheim HF et al (2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 362:9–17

    Article  PubMed  CAS  Google Scholar 

  3. Thakkar V, Ghobrial GM, Maulucci CM et al (2014) Nasal MRSA colonization: impact on surgical site infection following spine surgery. Clin Neurol Neurosurg 125:94–97

    Article  PubMed  Google Scholar 

  4. Costantini ST, Lach D, Goldfarb J et al (2013) Staphylococcus aureus colonization in children undergoing heart surgery. World J Pediatr Congenit Heart Surg 4:267–270

    Article  PubMed  Google Scholar 

  5. Chen AF, Heyl AE, Xu PZ et al (2013) Preoperative decolonization effective at reducing staphylococcal colonization in total joint arthroplasty patients. J Arthroplast 28:18–20

    Article  Google Scholar 

  6. Takahashi Y, Takesue Y, Uchino M et al (2014) Value of pre- and postoperative meticillin-resistant Staphylococcus aureus screening in patients undergoing gastroenterological surgery. J Hosp Infect 87:92–97

    Article  PubMed  CAS  Google Scholar 

  7. Ramirez MC, Marchessault M, Govednik-Horny C et al (2013) The impact of MRSA colonization on surgical site infection following major gastrointestinal surgery. J Gastrointest Surg 17:144–152

    Article  PubMed  Google Scholar 

  8. Savage JW, Anderson PA (2013) An update on modifiable factors to reduce the risk of surgical site infections. Spine J 13:1017–1029

    Article  PubMed  Google Scholar 

  9. Kanazawa A, Yamazaki T, Murakami M (2014) Correlation between nasal, skin bacterial carriage and surgical site infection in spinal operation. Seikeigeka 65:447–449

    Google Scholar 

  10. Mest DR, Wong DH, Shimoda KJ et al (1994) Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg 78:644–650

    Article  PubMed  CAS  Google Scholar 

  11. Kobayashi K, Imagama S, Ito Z et al (2017) Is a drain tip culture required after spinal surgery? Clin Spine Surg 30:356–359

    Article  PubMed  Google Scholar 

  12. Huang SS, Septimus E, Kleinman K et al (2013) Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 368:2255–2265

    Article  PubMed  Google Scholar 

  13. Wendt C, Schinke S, Württemberger M et al (2007) Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol 28:1036–1043

    Article  PubMed  CAS  Google Scholar 

  14. Mangram AJ, Horan TC, Pearson ML et al (1999) 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 27:97–132

    Article  PubMed  CAS  Google Scholar 

  15. Yano K, Minoda Y, Sakawa A et al (2009) Positive nasal culture of methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for surgical site infection in orthopedics. Acta Orthop 80:486–490

    Article  PubMed  PubMed Central  Google Scholar 

  16. Khan OA, Weston VC, Scammell BE (2002) Methicillin resident Staphylococcus aureus incidence and outcome in patients with neck of femur fractures. J Hosp Infect 51:185–188

    Article  PubMed  CAS  Google Scholar 

  17. Fierobe L, Decré D, Mùller C (1999) Methicillin-resistant Staphylococcus aureus as a causative agent of postoperative intra-abdominal infection: relation to nasal colonization. Clin Infect Dis 29:1231–1238

    Article  PubMed  CAS  Google Scholar 

  18. Lindgren U, Elmros T, Holm SE (1976) Bacteria in hip surgery. A study of routine aerobic and anaerobic cultivation from skin and closed suction wound drains. Acta Orthop Scand 47:320–323

    Article  PubMed  CAS  Google Scholar 

  19. Sørensen AI, Sørensen TS (1991) Bacterial growth on suction drain tips. Prospective study of 489 clean orthopedic operations. Acta Orthop Scand 62:451–454

    Article  PubMed  Google Scholar 

  20. Petsatodis G, Parziali M, Christodoulou AG et al (2009) Prognostic value of suction drain tip culture in determining joint infection in primary and non-infected revision total hip arthroplasty: a prospective comparative study and review of the literature. Arch Orthop Trauma Surg 129:1645–1649

    Article  PubMed  Google Scholar 

  21. Weinrauch P (2005) Diagnostic value of routine drain tip culture in primary joint arthroplasty. ANZ J Surg 75:887–888

    Article  PubMed  Google Scholar 

  22. Yamada T, Yoshii T, Egawa S et al (2016) Drain tip culture is not prognostic for surgical site infection in spinal surgery under prophylactic use of antibiotics. Spine 41:1179–1184

    Article  PubMed  Google Scholar 

  23. Bernard L, Pron B, Vuagnat A et al (2002) Groupe d’Etude sur l’Ostéite. The value of suction drainage fluid culture during aseptic and septic orthopedic surgery: a prospective study of 901 patients. Clin Infect Dis 34:46–49

    Article  PubMed  CAS  Google Scholar 

  24. Bertrand X, Slekovec C, Talon D (2010) Use of mupirocin-chlorhexidine treatment to prevent Staphylococcus aureus surgical-site infections. Future Microbiol 5:701–703

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, Nagoya, 466-8550, Japan

    Kazuyoshi Kobayashi, Kei Ando, Kenyu Ito, Mikito Tsushima, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Naoki Ishiguro & Shiro Imagama

Authors
  1. Kazuyoshi Kobayashi
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  2. Kei Ando
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  3. Kenyu Ito
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  4. Mikito Tsushima
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  5. Masayoshi Morozumi
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  6. Satoshi Tanaka
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  7. Masaaki Machino
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  8. Kyotaro Ota
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  9. Naoki Ishiguro
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  10. Shiro Imagama
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Corresponding author

Correspondence to Shiro Imagama.

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The authors have no financial conflicts of interest.

Additional information

This paper is designed and submitted acting on guideline of IRB of Nagoya University Graduate School of Medicine and these patients have signed consent form for this report.

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Kobayashi, K., Ando, K., Ito, K. et al. Prediction of surgical site infection in spine surgery from tests of nasal MRSA colonization and drain tip culture. Eur J Orthop Surg Traumatol 28, 1053–1057 (2018). https://doi.org/10.1007/s00590-018-2163-5

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  • DOI: https://doi.org/10.1007/s00590-018-2163-5

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