Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-20T09:21:15.372Z Has data issue: false hasContentIssue false
  • English
  • Français

Reduction of Surgical-Site Infections in Cardiothoracic Surgery by Elimination of Nasal Carriage of Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Jan A.J.W. Kluytmans ,
Johan W. Mouton ,
Marjolein F.Q. VandenBergh ,
Marie-José A.A.J. Manders ,
Alexander P.W.M. Maat ,
Johan H.T. Wagenvoort ,
Marc F. Michel  and
Henri A. Verbrugh
Jan A.J.W. Kluytmans*
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Johan W. Mouton
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Marjolein F.Q. VandenBergh
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Marie-José A.A.J. Manders
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Alexander P.W.M. Maat
Affiliation:
Department of Thoracic Surgery, University Hospital Rotterdam, Dijkzigt, The Netherlands
Johan H.T. Wagenvoort
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Marc F. Michel
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Henri A. Verbrugh
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
*
Department of Clinical Microbiology, Ignatius Hospital Breda, PO Box 90158, 4800 RK Breda, The Netherlands
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To test the hypothesis that perioperative elimination of nasal carriage of Staphylococcus aureus using mupirocin nasal ointment reduces the surgical-site infection (SSI) rate in cardiothoracic surgery.

Design:

Unblinded intervention trial with historical controls.

Setting:

A university hospital, tertiary referral center for cardiothoracic surgery.

Patients:

Consecutive patients undergoing cardiothoracic surgery between August 1, 1989, and February 1, 1991 (historical control group), and between March 1, 1991, and August 1, 1992 (intervention group).

Results:

The historical control group consisted of 928 patients and the intervention group of 868, of whom 752 actually were treated. The 116 patients who were unintentionally not treated were considered as a concurrent control group. In the intention-to-treat analysis, a significant reduction in SSI rate was observed after the intervention (historical-control group 7.3% and intervention group 2.8%; P<.0001). The SSI rate in the concurrent control group was significantly higher than in the treated group (7.8% and 2.0%, respectively; P=.0023). Resistance of S aureus to mupirocin was not observed.

Conclusion:

The results of this study indicate that perioperative elimination of nasal carriage using mupirocin nasal ointment significantly reduces the SSI rate in cardiothoracic surgery patients and warrants a prospective, randomized, placebo-controlled efficacy trial. This preventive measure may be beneficial in other categories of surgical patients as well.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 12 , December 1996 , pp. 780 - 785
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Doebbeling, BN, Pfaller, MA, Kuhns, KR, Massanari, RM, Behrendt, DM, Wenzel, RP. Cardiovascular surgery prophylaxis. A randomized, controlled comparison of cefazolin and cefuroxime. J Thorac Cardiovasc Surg 1990;99:981–989.CrossRefGoogle ScholarPubMed
2. Kluytmans, JAJW, Mouton, JW, Maat, APWM, Manders, MAAJ, Michel, MF, Wagenvoort, JHT. Surveillance of postoperative infections in thoracic surgery. J Hosp Infect 1994;27:139–147.CrossRefGoogle ScholarPubMed
3. Green, JW, Wenzel, RP. Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg 1977;185:264–268.CrossRefGoogle ScholarPubMed
4. Nelson, RM, Dries, DJ. The economic implications of infection in cardiac surgery. Ann Thorac Surg 1986;42:240–246.CrossRefGoogle ScholarPubMed
5. Loop, FD, Lytle, BW, Cosgrove, DM, et al. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 1990;49:179–187.CrossRefGoogle ScholarPubMed
6. Weinstein, HJ. The relation between the nasal-staphylococcal-carrier state and the incidence of postoperative complications. N Engl J Med 1959;260:1303–1308.CrossRefGoogle ScholarPubMed
7. Williams, REO, Jevons, PM, Shooter, RA, et al. Nasal staphylococci and sepsis in hospital patients. BMJ 1959;ii:658–663.CrossRefGoogle Scholar
8. Calia, FM, Wolinsky, E, Mortimer, EA, Abrams, JS, Rammelkamp, CH. Importance of the carrier state as a source of Staphylococcus aureus in wound sepsis. Journal of Hygiene (Cambridge) 1969;67:49–57.CrossRefGoogle ScholarPubMed
9. Kluytmans, JAJW, Mouton, JW, Ijzerman, EPF, et al. Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995;171:216–219.CrossRefGoogle ScholarPubMed
10. Doebbeling, BN, Breneman, DL, Neu, HC, the Mupirocin Collaborative Study Group. Elimination of Staphylococcus aureus nasal carriage in health care workers: analysis of six clinical trials with calcium mupirocin ointment. Clin Infect Dis 1993;17:466–474.CrossRefGoogle Scholar
11. Holton, DL, Nicolle, LE, Diley, D, Bernstein, K. Efficacy of mupirocin nasal ointment in eradicating Staphylococcus aureus nasal carriage in chronic hemodialysis patients. J Hosp Infect 1991;17:133–137.CrossRefGoogle Scholar
12. Reagan, DR, Doebbeling, BN, Pfaller, MA, et al. Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991;114:101–106.CrossRefGoogle ScholarPubMed
13. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Grace Emori, T. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.CrossRefGoogle ScholarPubMed
14. Fuchs, PC, Jones, RN, Barry, AL. Interpretive criteria for disk diffusion susceptibility testing of mupirocin, a topical antibiotic. J Clin Microbiol 1990;28:608–609.CrossRefGoogle ScholarPubMed
15. SAS institute Inc. SAS Users Guide. Gary, NC: SAS Institute Inc; 1989.Google Scholar
16. Chow, JW, Yu, VL. Staphylococcus aureus nasal carriage in hemodialysis patients. Arch Intern Med 1989;149:1258–1262.CrossRefGoogle ScholarPubMed
17. Goldblum, SE, Reed, WP, Ulrich, JA, Goldman, RS. Staphylococcal carriage and infections in hemodialysis patients. Dial Transplant 1978;7:1140–1148.Google Scholar
18. Yu, VL, Goetz, A, Wagener, M, et al. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. N Engl J Med 1986;315:91–96.CrossRefGoogle ScholarPubMed
19. Boelaert, JR, DeSmedt, RA, De Baere, YA, et al. The influence of calcium mupirocin nasal ointment on the incidence of Staphylococcus aureus infections in hemodialysis patients. Nephrol Dial Transplant 1989;4:278–281.CrossRefGoogle Scholar
20. Kluytmans, JAJW, Manders, M-J, van Bommel, E, Verbrugh, H. Elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients. Infect Control Hosp Epidemiol 1996;17:793–797.CrossRefGoogle ScholarPubMed
21. Doebbeling, BN, Breneman, DL, Neu, HC, et al. Elimination of Staphylococcus aureus nasal carriage in health care workers: analysis of six clinical trials with calcium mupirocin ointment. Clin Infect Dis 1993;17:466–474.CrossRefGoogle ScholarPubMed
22. Ulicny, KS, Hiratzka, LF The risk factors of median sternotomy infection: a current review. J Card Surg 1991;6:338–351.CrossRefGoogle ScholarPubMed
23. Sethi, GK, Copeland, JG, Moritz, T, Henderson, W, Zadina, K, Goldman, S. Comparison of postoperative complication between saphenous vein and IMA grafts to left anterior descending coronary artery. Ann Thorac Surg 1991;51:733–738.CrossRefGoogle ScholarPubMed
24. Ogtrop, ML. Effect of broth enrichment cultures on ability to detect carriage of Staphylococcus aureus . Antimicrob Agents Chemother 1996;39:2169. Letter.Google Scholar
25. Gilbart, J, Perry, CR, Slocombe, B. High-level mupirocin resistance in Staphylococcus aureus: evidence for two distinct isoleucyl-TRNA synthetases. Antimicrob Agents Chemother 1993;37:32–38.CrossRefGoogle ScholarPubMed
26. Chatfield, CA, O'Neill, WA, Cooke, RPD, et al. Mupirocin-resistant Staphylococcus aureus in a specialist school population. J Hosp Infect 1994;26:273–278.CrossRefGoogle Scholar
27. Cookson, BD, Lacey, RW, Noble, WC, Reeves, DS, Wise, R, Redhead, RJ. Mupirocin-resistant Staphylococcus aureus . Lancet 1990;335:1095–1096.CrossRefGoogle ScholarPubMed
28. Smith, GE, Kennedy, CTC. Staphylococcus aureus resistant to mupirocin. J Antimicrob Chemother 1988;21:141–142.CrossRefGoogle ScholarPubMed
29. Hudson, IRB. The efficacy of intranasal mupirocin in the prevention of staphylococcal infections: a review of recent experience. J Hosp Infect 1994;27:81–98.CrossRefGoogle ScholarPubMed