Does Nasal Carriage of Staphylococcus aureus Increase the Risk of Postoperative Infections After Elective Spine Surgery: Do Most Infections Occur in Carriers?

Owoicho Adogwa, Victoria D. Vuong, Aladine A. Elsamadicy, Daniel T. Lilly, Shyam A. Desai, Syed Khalid, Joseph Cheng, Carlos A. Bagley

Research output: Contribution to journalArticle

Abstract

Background: Wound infections after adult spinal deformity surgery place a high toll on patients, providers, and the healthcare system. Staphylococcus aureus is a common cause of postoperative wound infections, and nasal colonization by this organism may be an important factor in the development of surgical site infections (SSIs). The aim is to investigate whether post-operative surgical site infections after elective spine surgery occur at a higher rate in patients with methicillin-resistant S. aureus (MRSA) nasal colonization. Methods: Consecutive patients undergoing adult spinal deformity surgery between 2011–2013 were enrolled. Enrolled patients were followed up for a minimum of 3 months after surgery and received similar peri-operative infection prophylaxis. Baseline characteristics, operative details, rates of wound infection, and microbiologic data for each case of post-operative infection were gathered by direct medical record review. Local vancomycin powder was used in all patients and sub-fascial drains were used in the majority (88%) of patients. Results: 1200 operative spine cases were performed for deformity between 2011 and 2013. The mean ± standard deviation age and body mass index were 62.08 ± 14.76 years and 30.86 ± 7.15 kg/m2, respectively. 29.41% had a history of diabetes. All SSIs occurred within 30 days of surgery, with deep wound infections accounting for 50% of all SSIs. Of the 34 (2.83%) cases of SSIs that were identified, only 1 case occurred in a patient colonized with MRSA. Conclusion: Our study suggests that the preponderance of SSIs occurred in patients without nasal colonization by methicillin-resistant S. aureus. Future prospective multi-institutional studies are needed to corroborate our findings.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Surgical Wound Infection
Nose
Staphylococcus aureus
Spine
Infection
Wound Infection
Methicillin-Resistant Staphylococcus aureus
Vancomycin
Ambulatory Surgical Procedures
Powders
Medical Records
Body Mass Index
Delivery of Health Care

Keywords

  • Methicillin-resistant Staphylococcus aureus
  • Nasal colonization
  • Postoperative complications
  • Spine
  • Surgical site infections

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Does Nasal Carriage of Staphylococcus aureus Increase the Risk of Postoperative Infections After Elective Spine Surgery : Do Most Infections Occur in Carriers? / Adogwa, Owoicho; Vuong, Victoria D.; Elsamadicy, Aladine A.; Lilly, Daniel T.; Desai, Shyam A.; Khalid, Syed; Cheng, Joseph; Bagley, Carlos A.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Adogwa, Owoicho ; Vuong, Victoria D. ; Elsamadicy, Aladine A. ; Lilly, Daniel T. ; Desai, Shyam A. ; Khalid, Syed ; Cheng, Joseph ; Bagley, Carlos A. / Does Nasal Carriage of Staphylococcus aureus Increase the Risk of Postoperative Infections After Elective Spine Surgery : Do Most Infections Occur in Carriers?. In: World Neurosurgery. 2018.
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abstract = "Background: Wound infections after adult spinal deformity surgery place a high toll on patients, providers, and the healthcare system. Staphylococcus aureus is a common cause of postoperative wound infections, and nasal colonization by this organism may be an important factor in the development of surgical site infections (SSIs). The aim is to investigate whether post-operative surgical site infections after elective spine surgery occur at a higher rate in patients with methicillin-resistant S. aureus (MRSA) nasal colonization. Methods: Consecutive patients undergoing adult spinal deformity surgery between 2011–2013 were enrolled. Enrolled patients were followed up for a minimum of 3 months after surgery and received similar peri-operative infection prophylaxis. Baseline characteristics, operative details, rates of wound infection, and microbiologic data for each case of post-operative infection were gathered by direct medical record review. Local vancomycin powder was used in all patients and sub-fascial drains were used in the majority (88{\%}) of patients. Results: 1200 operative spine cases were performed for deformity between 2011 and 2013. The mean ± standard deviation age and body mass index were 62.08 ± 14.76 years and 30.86 ± 7.15 kg/m2, respectively. 29.41{\%} had a history of diabetes. All SSIs occurred within 30 days of surgery, with deep wound infections accounting for 50{\%} of all SSIs. Of the 34 (2.83{\%}) cases of SSIs that were identified, only 1 case occurred in a patient colonized with MRSA. Conclusion: Our study suggests that the preponderance of SSIs occurred in patients without nasal colonization by methicillin-resistant S. aureus. Future prospective multi-institutional studies are needed to corroborate our findings.",
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T2 - Do Most Infections Occur in Carriers?

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AU - Vuong, Victoria D.

AU - Elsamadicy, Aladine A.

AU - Lilly, Daniel T.

AU - Desai, Shyam A.

AU - Khalid, Syed

AU - Cheng, Joseph

AU - Bagley, Carlos A.

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AB - Background: Wound infections after adult spinal deformity surgery place a high toll on patients, providers, and the healthcare system. Staphylococcus aureus is a common cause of postoperative wound infections, and nasal colonization by this organism may be an important factor in the development of surgical site infections (SSIs). The aim is to investigate whether post-operative surgical site infections after elective spine surgery occur at a higher rate in patients with methicillin-resistant S. aureus (MRSA) nasal colonization. Methods: Consecutive patients undergoing adult spinal deformity surgery between 2011–2013 were enrolled. Enrolled patients were followed up for a minimum of 3 months after surgery and received similar peri-operative infection prophylaxis. Baseline characteristics, operative details, rates of wound infection, and microbiologic data for each case of post-operative infection were gathered by direct medical record review. Local vancomycin powder was used in all patients and sub-fascial drains were used in the majority (88%) of patients. Results: 1200 operative spine cases were performed for deformity between 2011 and 2013. The mean ± standard deviation age and body mass index were 62.08 ± 14.76 years and 30.86 ± 7.15 kg/m2, respectively. 29.41% had a history of diabetes. All SSIs occurred within 30 days of surgery, with deep wound infections accounting for 50% of all SSIs. Of the 34 (2.83%) cases of SSIs that were identified, only 1 case occurred in a patient colonized with MRSA. Conclusion: Our study suggests that the preponderance of SSIs occurred in patients without nasal colonization by methicillin-resistant S. aureus. Future prospective multi-institutional studies are needed to corroborate our findings.

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KW - Postoperative complications

KW - Spine

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