The NEJM has an article this month about the prevention of surgical site infections by identifying and treating those patients who are colonized with staphylococcus aureus. It's a randomized trial that used PCR assays of nasal swabs to identify patients colonized with methicillin susceptible staoh aureus. Those patients noted to be positive were then treated with mupirocin nasal ointment and a chlorhexidine soap scrub prior to elective surgery. Infection rates were halved compared to the placebo group.
Interesting paper but it ought to be noted that these patients were carriers of the methocillin susceptible strain of staph aureus rather than the more virulent MRSA. It would be interesting to see if the results were as profound if we treated all MRSA carriers.
Furthermore, as with any paper, we have to ask ourselves what we're supposed to do with the data accumulated. How ought it to change clinical practice? Do we need to start screening all elective surgery patients? Should every carrier be treated, no matter what the operation to be performed is?
I've done close to 500 inguinal hernia in my brief career as a general surgeon. I've never had a wound infection. (Knocking on wood.) Do I really need to be checking all my patients for staph? PCR assays cost money, as do treatment regimens with mupirocin. Is it cost effective to implement MSSA/MRSA screening for all elective surgery? Or just certain operations (like heart surgery, bowel cases, ortho procedures, etc.)
I got it! Pre-op eval with urine culture, nasal swab, lower extremity us, mupirocin ointment nasally, 2-3 pre-op antibiotics, and most importantly rush through the case as fast as you can. Let's cut costs!
I also like the idea of restructuring OR suites into large scale versions of those UV blue light receptacles that barbers use to sterilize (hopefully) their combs and razors.
Two of the big ID guys at my hospital are well-known for self-treating with mupirocin in an attempt to reduce their own colonization with MRSA.
Ironically, a day before this article came out, a bunch of the other medicine attendings (non-ID) were laughing about it. I wonder if they're still so amused?
Are there any studies with patients all being MRSA carriers?
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