Impact of skin and nasal decontamination before cardiac surgery on postoperative Staphylococcus infection rate in children

Abstract

BackgroundPostoperative infections occur in about 10% of pediatric cardiac surgeries, involving Staphylococcus aureus in most of the cases. Nasal decontamination of Staphylococcus aureus with mupirocin has been reported to reduce postoperative Staphylococcus aureus infections after cardiac surgery in adults, but the effect of preoperative decontamination in children undergoing cardiac surgery has not been enough studied to determine a consensus. AimsWe tried to evaluate the impact of systematic preoperative decolonization with intra nasal mupirocin application and chlorhexidine soap skin washing, on postoperative Staphylococcus infection in children undergoing cardiac surgery. MethodsWe conducted a monocentric retrospective study including children from 7days-old to 18 years-old undergoing cardiac surgery. Our population was divided in three groups according to decolonization protocol (groupN: no decolonization, group T: targeted decolonization in Staphylococcus aureus carriers only, and group S: systematic decolonization). ResultsThree hundred and ninety three children were included between October 2011 and August 2015(122 in group N, 148 in group T and 123 in group S). Staphylococcus infection rate significantly decreased in group S compared to group N (0.8% vs. 7.7%; P<0.05) and tended to decrease in group S compared to group T (0.8% vs. 4.7%; P=0.06). Systematic decontamination also significantly reduced the rate of infections starting from the skin (including surgical site infections and bloodstream infections), but had no effect on the rate of pulmonary infections. The lack of decontamination was associated with a higher risk of postoperative Staphylococcus infection (15% vs. 41%, P<0.05). ConclusionOur study suggests that systematic preoperative skin and nasal decontamination decrease postoperative SI in children undergoing cardiac surgery.