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Importance of the carrier state as a source of Staphylococcus aureus in wound sepsis*

Published online by Cambridge University Press:  15 May 2009

Frank M. Calia ,
Emanuel Wolinsky ,
Edward A. Mortimer Jr ,
Jerome S. Abrams  and
Charles H. Rammelkamp Jr
Frank M. Calia
Affiliation:
From the Departments of Medicine, Pediatrics and Surgery, Cleveland Metropolitan General Hospital, and Case Western Reserve University School of Medicine, Cleveland, Ohio 44109.
Emanuel Wolinsky
Affiliation:
From the Departments of Medicine, Pediatrics and Surgery, Cleveland Metropolitan General Hospital, and Case Western Reserve University School of Medicine, Cleveland, Ohio 44109.
Edward A. Mortimer Jr
Affiliation:
From the Departments of Medicine, Pediatrics and Surgery, Cleveland Metropolitan General Hospital, and Case Western Reserve University School of Medicine, Cleveland, Ohio 44109.
Jerome S. Abrams
Affiliation:
From the Departments of Medicine, Pediatrics and Surgery, Cleveland Metropolitan General Hospital, and Case Western Reserve University School of Medicine, Cleveland, Ohio 44109.
Charles H. Rammelkamp Jr
Affiliation:
From the Departments of Medicine, Pediatrics and Surgery, Cleveland Metropolitan General Hospital, and Case Western Reserve University School of Medicine, Cleveland, Ohio 44109.
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The relationship of pre-operative nasal and skin carriage of Staphylococcus aureus to wound colonization and sepsis was studied in 269 patients. Thirty-seven per cent of 96 carriers developed wound colonization as compared to 16 % among non-carriers (a statistically significant difference). The wound sepsis rates were 17 % and 9 % respectively. The combination of nasal and skin carriage was an important factor, since the sepsis rate among skin carriers (most of whom were nasal carriers as well) was 22%. Among carriers, the homologous strain was recovered from the majority of wound colonizations and from all instances of wound sepsis. A carrier strain also was recovered from 52% of the wounds colonized and from 50% of septic wounds in the entire study group. Profuse nasal carriage resulted in a significantly greater number of septic wounds (31%) than sparse carriage (9%). Wound cultures before closure, and skin from the initial incision site only once yielded a patient's carrier strain or a strain of Staph. aureus that was later recovered from the wound. The results indicate that measures designed to control the carrier state or to isolate the wound from the external environment should reduce wound sepsis by approximately one half.

Excellent technical aid was furnished by Eleanor Ford, R. N., Edith E. Silverman, Adrienne Marus, M. S., and Patricia Welch.

Type
Research Article
Information
Journal of Hygiene , Volume 67 , Issue 1 , March 1969 , pp. 49 - 57
Copyright
Copyright © Cambridge University Press 1969

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