Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

Abstract

Background: Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA)is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution. Methods: Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated. Results: The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were "duration of preoperative hospitalization" and "preoperative MRSA colonization," intraoperative factors were "Aristotle basic complexity score," "operation time," "cardiopulmonary bypass circuit volume" and "lowest rectal temperature." And postoperative factor was "blood transfusion volume." Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis. Conclusions: SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries.

Clinical‐care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital

“…The CCPPM was developed considering the well-known information that S. aureus is a major risk for mediastinitis in cardiac surgery. 11,12 The use of chlorhexidine was instructed to be performed for 5 days before surgery since chlorhexidine has the theoretical advantage of longer antimicrobial activity (>48 hours), compared with 2 hours of isopropyl alcohol alone. 13 The prevalence of mediastinitis before implementation of the CCPPM was 1.4%, which is similar to the general incidence previously described in the literature.…”

Systematic review of a patient care bundle in reducing staphylococcal infections in cardiac and orthopaedic surgery

“…[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Nine of the eligible studies 19,22,24,25,[27][28][29][30]35 included cardiac patients and nine 20,21,23,26,[31][32][33]36,37 included orthopaedic patients; the remaining studies included both types of patients. Two cardiac studies were on paediatric populations 19,25 and the remaining were all adults. Decolonization protocols for observational studies were more varied than those in RCTs (Table 1).…”

“…Decolonization protocols for observational studies were more varied than those in RCTs (Table 1). Mupirocin (2% ointment) was used under different regimens by 18 studies, 19,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] and povidone-iodine was used in two studies as the nasal decolonization agent. 21,33 Chlorhexidine was used for skin decolonization in patients in the form of soaps for showering 19,20,[26][27][28][29]34,35,37 or wipes for skin cleansing.…”

“…The National Healthcare Safety Network definition of SSIs was adopted by 14 studies. [20][21][22][23][25][26][27][28]30,31,[34][35][36][37] All-cause SSIs, S. aureus SSIs, SSIs due to MRSA and MSSA were reported by the included observational studies. The meta-analysis of all 19 observational studies found a significant decrease in risk of all-cause SSIs for the bundled treatment compared with its comparator (RR = 0.49, 95% CI = (0.41, 0.59), I 2 = 46.86%) (Fig.…”

Preoperative colonization in pediatric cardiac surgery and its impact on postoperative infections

“…There are conflicting results on the association between nasal or rectal colonization and clinically diagnosed infections in the setting of pediatric cardiac surgery. Some authors claim an association between nasal colonization by methicillin‐resistant Staphylococcus aureus (MRSA) and surgical site infection following heart surgery in pediatric patients, while others could not confirm this finding and others did not consider the patient colonization within the potential risk factors for infections . In pediatric cardiac surgery patients, the preoperative screening for colonization is not yet a standard of care …”