The Prevalence of MRSA Nasal Carriage in Preoperative Pediatric Orthopaedic Patients.

J J Walrath,J E Latorre,W L Hennrikus,C Zalonis,A M Dyer

doi:10.1155/2016/5646529

Abstract

Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been described as a risk factor for postsurgical infection. The purpose of this study is to determine the prevalence of MRSA in pediatric orthopaedic patients and whether being a MRSA carrier is a predictor of postoperative infection. Six hundred and ninety-nine consecutive pediatric patients who underwent MRSA nasal screening prior to surgery were studied. Postoperative cultures, total surgical site infections (SSIs), and epidemiological and surgical prophylaxis data were reviewed. Forty-four of 699 patients (6.29%) screened positive for MRSA. Nine of the 44 patients (20.5%) that screened positive for MRSA had a subsequent SSI compared to 10 of the 655 patients (1.52%) that screened negative (p < 0.05). All 9 patients with a SSI had myelomeningocele. The prevalence of MRSA was 6.30% and was predictive of postoperative infection. Children with myelomeningocele were at the highest risk for having a positive MRSA screening and developing SSI.

Highlights

Methicillin-resistant Staphylococcus aureus (MRSA) is bacterial pathogen responsible for a variety of infections in both children and adults [1,2,3,4]
The purpose of this study is to determine the prevalence of MRSA nasal carriage in preoperative pediatric orthopaedic patients, to identify risk factors of surgical site infections (SSIs) due to MRSA, and to determine if MRSA nasal carriage is a predictor of postoperative infection in these patients
We propose that MRSA nasal carriage would be predictive of postoperative infection in our pediatric population

Summary

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) is bacterial pathogen responsible for a variety of infections in both children and adults [1,2,3,4]. The prevalence of MRSA colonization has been found to be 0.18%–7.2% [7,8,9] in the general inpatient setting and up to 4%–8% in intensive care units [10]. A Welsh study reported colonization rates to be as high as 5.3% in orthopaedic and surgical wards [6]. Previous authors have suggested that the risk for subsequent surgical site infections (SSIs) with MRSA in asymptomatic, preoperative nasal carriage of MRSA increases [11,12,13,14]. MRSA SSIs are of particular concern, as these infections are associated with substantial morbidity and mortality, longer hospital stays, higher rates of rehospitalization, and increased cost of health care [15,16,17,18,19,20]

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