Staphylococcus aureus colonization and risk of surgical site infection in children undergoing clean elective surgery

Abstract

Staphylococcus aureus persistently colonizes the skin and nasopharynx of approximately 20% to 30% of individuals, with the highest rates in younger children. To avoid clinical problems for carriers and the spread of S aureus to other hospitalized patients, screening and decolonization of carriers undergoing surgery has been recommended. However, the best approach to patients undergoing clean surgery is not precisely defined. To evaluate whether children carrying S aureus admitted to the hospital for clean elective surgery have an increased risk of postoperative surgical infections, 393 infants and children (77.1% males; mean age ± standard deviation, 7.6 ± 4.5 years) who were scheduled for clean elective surgery procedures were evaluated for S aureus carriage on the day of intervention and 5 days after it. Both anterior nares and pharyngeal swabs were collected. S aureus was identified using the RIDAGENE methicillin-resistant S aureus (MRSA) system (R-Biopharm AG, Darmstadt, Germany), according to the manufacturer's instructions. At admission, 138 (35.1%) children screened positive for S aureus. MRSA was identified in 40 (29.0% of S aureus positive subjects) cases. The carriage rates of S aureus and MRSA varied considerably with age, and in children <2 years old the rate was significantly lower than in any other age group (P < .05). Surgical site infection was demonstrated in 4 out of 109 (3.7%) children who were initially colonized by S aureus and in 5 out of 201 (2.5%) children with a negative screening, without any statistically significant difference between groups (P = .72). None of these children had MRSA. These results seem to suggest that children undergoing clean elective surgery do not need to be screened for S aureus colonization because, although positive, they have no increased risk of surgical site infection. Following this statement, preoperative procedures should be simplified with relevant advantages from a clinical, social, and economic point of view.

A review on biocide reduced susceptibility due to plasmid‐borne antiseptic‐resistant genes—special notes on pharmaceutical environmental isolates

“…Furthermore, 20–30% of the general population are so‐termed ‘Staph carriers’ (Esposito et al . ). Hence, there is a high chance of personnel carrying drug‐resistant S. aureus , especially with people who have pimples, impetigo, boils, cellulites, furuncles, carbuncles, scalded skin syndrome and abscess, into the cleanroom.…”

Detection of Oxacillin/Cefoxitin Resistance in Staphylococcus aureus Present in Recurrent Tonsillitis

“…Another study which was carried out in Iran investigated the presence of MRSA in children who attended kindergarten, without any known factor for MRSA colonization; in total, 354 children were analyzed, among them, 20 children (5.8%) tested positive for colonization of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) [ 35 , 36 ].…”

Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

“…In contrast with the aforementioned studies by Inoue and Katayanagi [ 25 , 35 ], an Italian study conducted by Esposito et al highlighted that MRSA colonization does not represent a risk factor for those children undergoing elective surgery: SSI rates amongst S. aureus colonized children were 3.7%, not significantly different from non-colonized children (2.5%, p = 0.72) [ 42 ]. It must be noted that Inoue et al’s study [ 35 ] focused on neonatal surgery and Katayanagi et al’s study [ 25 ] focused on pediatric cardiac surgery, whereas Esposito’s focused on clean elective surgery in the pediatric population in general [ 42 ].…”