Preoperative Staphylococcus Decolonization in Elective Spine Cases is Effective

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Authors: Chen AF, Farber NJ, Zammerilla LL, Nowicki AL, Rao N, Kang JD, Lee JY, Donaldson WF
University of Pittsburgh Pittsburgh, PA

Title: Preoperative Staphylococcus Decolonization in Elective Spine Cases is Effective

Background: To prevent surgical site infections (SSIs) after elective spine cases, patients are screened for MSSA and MRSA and decolonized prior to surgery if positive. However, no studies have evaluated if current treatment protocols successfully decolonizes MRSA/MSSA in elective spine patients.

Hypothesis/Purpose: Do current treatment protocols result in successful decolonization of MRSA/MSSA in elective spine patients?

Methods: A prospective study was conducted on 156 elective spine patients (26 primary cervical, 89 primary lumbar, 7 revision cervical, 34 revision lumbar). All patients were screened for nasal MRSA/MSSA colonization 2-6 weeks prior to surgery. Those positive for MRSA/MSSA underwent decolonization using intranasal mupirocin and chlorhexidine body wash. Patients were reswabbed on the day of surgery to determine if the decolonization protocol was effective. Pre-operative swabs were compared to operative swabs using the McNemar test.

Results: For elective primary lumbar spine cases, 24 patients (27%) were positive for MSSA colonization and 5 patients (5.6%) were positive for MRSA colonization. On the day of surgery, 1 patient (1%) was positive for MRSA colonization, 2 patients (2%) who underwent decolonization were persistently positive for MSSA, and 4 patients (5%) who were preoperatively negative developed MSSA colonization on the day of surgery. The reduction in MSSA colonization was significant (p<0.001), while the eradication of MRSA colonization was 98.9% (p=0.125). The compliance rate was 100%. In the primary lumbar spine patients, there were 3 SSIs (3%) that developed during follow-up (average 94.6 days). One patient was MSSA colonized prior to surgery and developed a Group B Streptococcus infection, while the other infected patients (MRSA&MSSA) were not positive for MRSA or MSSA colonization prior to surgery. Primary cervical, revision lumbar and revision cervical spine cases had 11 total MSSA infections that were cleared on the day of surgery.

Discussion: Our study demonstrates that current decolonization protocols using mupirocin and chlorhexidine effectively reduce MRSA/MSSA colonization in elective spine patients, but do not completely eradicate MRSA/MSSA from the nares. Future actions should be taken to further reduce bacterial burden prior to elective spine cases.

Conclusion: Current decolonization protocols using mupirocin and chlorhexidine are effect for reducing Staphylococcus colonization in elective spine patients.