Saraswat Manoj K, Magruder Jonathan T, Crawford Todd C, Gardner Julia M, Duquaine Damon, Sussman Marc S, Maragakis Lisa L, Whitman Glenn J
Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Ann Thorac Surg. 2017 Oct;104(4):1349-1356. doi: 10.1016/j.athoracsur.2017.03.018. Epub 2017 Jun 1.
We assessed the impact of preoperative Staphylococcus aureus screening and targeted decolonization on the incidence of postoperative methicillin-resistant S aureus (MRSA) colonization, intensive care unit MRSA transmission, and surgical site infections in cardiac surgery patients.
We reviewed medical records for all adult patients during two periods: preintervention (January 2007 to April 2010) and intervention (January 2011 to December 2014). In the intervention period, we performed nasal screening for methicillin-sensitive S aureus and MRSA using polymerase chain reaction within 30 days of the operation. Colonized patients received intranasal mupirocin twice daily and chlorhexidine baths daily for 5 days; patients colonized with MRSA also received prophylactic vancomycin plus cefazolin with contact isolation precautions. Nasal surveillance for MRSA was performed on intensive care unit admission and weekly thereafter. Multivariable logistic regression models were constructed to determine risk factors for postoperative MRSA colonization, and surgical site infections and the impact of our screening program was assessed in these models. Poisson regression was used to assess MRSA transmission.
Comparing 2,826 preintervention and 4,038 intervention patients, cases differed in age, diabetes mellitus, preoperative infection, preoperative length of stay, and bypass time (all p ≤ 0.03). Intervention patients had risk-adjusted reductions in MRSA colonization (odds ratio 0.53, 95% confidence interval [CI]: 0.37 to 0.76, p < 0.001), transmission (incidence rate ratio 0.29, 95% CI: 0.13 to 0.65, p = 0.002), and surgical site infections (odds ratio 0.58, 95% CI: 0.40 to 0.86, p = 0.007). Increased duration of preoperative decolonization therapy was associated with decreased postoperative MRSA colonization (odds ratio 0.73, 95% CI: 0.53 to 1.00, p = 0.05).
Preoperative S aureus screening with targeted decolonization was associated with reduced MRSA colonization, transmission, and surgical site infections. Duration of preoperative therapy correlated with decreased frequency of postoperative MRSA colonization.
我们评估了术前金黄色葡萄球菌筛查和针对性去定植对心脏手术患者术后耐甲氧西林金黄色葡萄球菌（MRSA）定植、重症监护病房MRSA传播及手术部位感染发生率的影响。
我们回顾了两个时期所有成年患者的病历：干预前（2007年1月至2010年4月）和干预期（2011年1月至2014年12月）。在干预期，我们在手术30天内使用聚合酶链反应对甲氧西林敏感金黄色葡萄球菌和MRSA进行鼻腔筛查。定植患者每天两次鼻用莫匹罗星，每天用洗必泰沐浴5天；MRSA定植患者还接受预防性万古霉素加头孢唑林并采取接触隔离预防措施。在重症监护病房入院时及之后每周对MRSA进行鼻腔监测。构建多变量逻辑回归模型以确定术后MRSA定植的危险因素，并在这些模型中评估我们筛查方案的影响。使用泊松回归评估MRSA传播。
比较2826例干预前患者和4038例干预患者，病例在年龄、糖尿病、术前感染、术前住院时间和体外循环时间方面存在差异（所有p≤0.03）。干预患者在MRSA定植（比值比0.53，95%置信区间[CI]：0.37至0.76，p<0.001）、传播（发病率比0.29，95%CI：0.13至0.65，p = 0.002）和手术部位感染（比值比0.58，95%CI：0.40至0.86，p = 0.007）方面经风险调整后有所降低。术前去定植治疗时间延长与术后MRSA定植减少相关（比值比0.73，95%CI：0.53至1.00，p = 0.05）。
术前金黄色葡萄球菌筛查及针对性去定植与MRSA定植、传播及手术部位感染减少相关。术前治疗时间与术后MRSA定植频率降低相关。
