Humphreys H, Becker K, Dohmen P M, Petrosillo N, Spencer M, van Rijen M, Wechsler-Fördös A, Pujol M, Dubouix A, Garau J
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland.
Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
J Hosp Infect. 2016 Nov;94(3):295-304. doi: 10.1016/j.jhin.2016.06.011. Epub 2016 Jun 18.
Surgical site infections (SSIs) are among the most common healthcare-associated infections, and contribute significantly to patient morbidity and healthcare costs. Staphylococcus aureus is the most common microbial cause. The epidemiology of S. aureus is changing with the dissemination of newer clones and the emergence of mupirocin resistance. The prevention and control of SSIs is multi-modal, and this article reviews the evidence on the value of screening for nasal carriage of S. aureus and subsequent decolonization of positive patients pre-operatively. Pre-operative screening, using culture- or molecular-based methods, and subsequent decolonization of patients who are positive for meticillin-susceptible S. aureus and meticillin-resistant S. aureus (MRSA) reduces SSIs and hospital stay. This applies especially to major clean surgery, such as cardiothoracic and orthopaedic, involving the insertion of implanted devices. However, it requires a multi-disciplinary approach coupled with patient education. Universal decolonization pre-operatively without screening for S. aureus may compromise the capacity to monitor for the emergence of new clones of S. aureus, contribute to mupirocin resistance, and prevent the adjustment of surgical prophylaxis for MRSA (i.e. replacement of a beta-lactam agent with a glycopeptide or alternative).
手术部位感染（SSIs）是最常见的医疗相关感染之一，对患者的发病率和医疗成本有重大影响。金黄色葡萄球菌是最常见的微生物病因。随着新菌株的传播和莫匹罗星耐药性的出现，金黄色葡萄球菌的流行病学正在发生变化。SSIs的预防和控制是多模式的，本文综述了术前筛查金黄色葡萄球菌鼻腔携带情况以及对阳性患者进行后续去定植的价值的相关证据。使用基于培养或分子的方法进行术前筛查，以及对甲氧西林敏感金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌（MRSA）阳性的患者进行后续去定植，可减少SSIs和住院时间。这尤其适用于涉及植入装置插入的大型清洁手术，如心胸外科和骨科手术。然而，这需要多学科方法并结合患者教育。术前不筛查金黄色葡萄球菌而进行普遍去定植可能会损害监测金黄色葡萄球菌新菌株出现的能力，导致莫匹罗星耐药，并妨碍对MRSA手术预防措施的调整（即用糖肽类或其他药物替代β-内酰胺类药物）。
