Preoperative Staphylococcus aureus Carriage and Risk of Surgical Site Infection After Cardiac Surgery in Children Younger than 1 year: A Pilot Cohort Study

Abstract

Surgical site infections (SSI) increase length of stay, morbidity, mortality and cost of hospitalization. Staphylococcus aureus (SA) carriage is a known risk factor of SSI in adults, but its role in pediatrics remains uncertain. The main objective of this pilot prospective monocentric cohort study was to describe the prevalence of SA colonization in children under 1 year old before cardiac surgery. The secondary objectives were to compare the incidence of SSI and other nosocomial infections (NI) between preoperative carriers and non-carriers. From May 2012 to November 2013, all children <1 year old undergoing cardiac surgery under cardiopulmonary bypass underwent preoperative methicillin-resistant (MRSA) and methicillin-sensitive SA (MSSA) screening using real-time PCR. The only exclusion criterion was invalid PCR. All patients were followed up to 1 year after the surgery regarding SSI and other nosocomial infections. Among the 68 studied patients, SA colonization prevalence was 26.5%, comprising 23.5% MSSA and 2.9% MRSA. There was no significant difference between colonized and non-colonized children regarding SSI rate (16.7 vs 20%; p = 0.53), but ventilator-associated pneumonia rate was significantly higher among the SA carriers (22.2 vs 2%; p < 0.05). The colonization rate was different depending on the age of the patients (p < 0.05). This pilot study highlights that colonization with MSSA is frequent whereas MRSA prevalence is low in our population. In this cohort, there was no association between SA colonization and SSI incidence but further studies are needed to analyze this association.

Prevalence of Staphylococcus aureus nasal carriage and surgical site infection rate among patients undergoing elective cardiac surgery

“…The reported prevalence of MSSA nasal carriage in the general population ranges from 20% to 42% (Chen et al, 2017;del Rio et al, 2009;Macher et al, 2017;Reid et al, 2017). The prevalence of MSSA nasal carriage was reported to be approximately 24% in both a Chinese population and a French population (Chen et al, 2017;Macher et al, 2017). Interestingly, the prevalence of MSSA nasal carriage was reported to be as high as 42% in children in southern Botswana (Reid et al, 2017).…”

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

“…At the univariate analysis, he found a significant association between colonization and both surgical site infection and mediastinitis. On the contrary, in a recent pilot study including less than 100 children, Macher and coauthors did not find any relationship between Staphylococcus aureus carriage and subsequent occurrence of SWI. In a case series, other authors observed the occurrence of SWI by the same microorganism colonizing the nasal swabs, therefore assuming a strict relationship between the two patterns.…”

“…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 …”

Device and surgical procedure-related infections in Canadian acute care hospitals from 2011 to 2020

“…A 2009–2012 intervention study of neonates undergoing cardiac surgery at a New York tertiary-care centre found pre and post-intervention paediatric cardiac SSI rates of 6.2 and 5.8/100 surgeries, respectively (( 27 )). In France, 19% of patients younger than one year of age and undergoing cardiac surgery presented with a SSI during the study period, between 2012 and 2013 (( 28 )). The hospital-acquired cardiac-SSI rate at two New York hospitals was 1.4 infections per 100 procedures within 90 days for patients younger than 18 years of age, based on a retrospective study from 2010–2012 (( 29 )).…”