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Swabbing Surgical Sites Does Not Improve the Detection of Staphylococcus aureus Carriage in High-Risk Surgical Patients

Session: Poster Abstract Session: Surgical Site Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: A major risk factor for surgical site infections (SSIs) is Staphylococcus aureus carriage. S. aureus carriers have a 9X greater risk for SSIs compared with non-carriers. Preoperative screening for S. aureus carriage is controversial. Yet, targeted screening in high-risk patients or from clinically relevant sites may be beneficial. We aimed to determine whether S. aureus detection in high-risk surgical patients would be increased by culturing surgical sites, in addition to the nares, vs nares-only culturing.

Methods:   Adults undergoing preoperative evaluations in orthopedic and neurosurgical clinics were eligible for participation. Patients with active infections or use of anti-staphylococcal antibiotics within 90 days of evaluation were excluded. For each subject, specimens were collected from the nares and from the proposed surgical site with Transporter Liquid Stuart Culture Swabs (HealthLink, Jacksonville, FL). Samples were inoculated onto methicillin-resistant S. aureus (MRSA)-selective chromogenic agar plates and blood agar plates.

Results:   Of the 150 subjects, 80 (53.3%) were women and 70 (46.7%) men. The mean age was 61 years and 77/150 (51.3%) had a BMI > 30. Proposed operations included knee or hip arthroplasty, spine surgery, and brain stimulator placement. Culture results were available for 147/150 subjects. Of the 147 surgical site cultures, 54 (36.7%), 51 (34.7%), and 28 (19.0%) were collected from knee, hip, and lumbar sites, respectively; the remaining 14 (9.5%) were from cervical, thoracic, or infraclavicular sites. Overall, 35/147 (23.8%) nasal cultures grew S. aureus; 29/147 (19.7%) grew methicillin-susceptible S. aureus (MSSA), and 6/147 (4.1%) grew MRSA. Only 2/147 (1.4%) surgical site cultures grew S. aureus; both grew MSSA and MSSA was cultured also from the nasal swabs of these subjects. Using nasal culture + surgical site culture as “true positive”, the percentage of additional S. aureus carriers detected by the addition of surgical site screening was zero as compared to nasal screening alone.

Conclusion:   The detection of S. aureus carriage in high-risk surgical patients is not improved by swabbing surgical sites in addition to the nares.

Jennifer Brown, MD1, Chin-Shang Li, Ph.D.2, Mauro Giordani, MD3, Kiarash Shahlaie, MD, PhD4, Eric Klineberg, MD3, Joanna Tripet-Diel, MPH1, Marie Ihara, BS1 and Stuart Cohen, MD, FIDSA, FSHEA1, (1)Division of Infectious Diseases, University of California, Davis Medical Center, Sacramento, CA, (2)Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Davis, CA, (3)Department of Orthopedic Surgery, University of California, Davis Medical Center, Sacramento, CA, (4)Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, CA


J. Brown, None

C. S. Li, None

M. Giordani, None

K. Shahlaie, None

E. Klineberg, None

J. Tripet-Diel, None

M. Ihara, None

S. Cohen, None

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