Effects of preoperative Staphylococcus aureus screening and targeted decolonization bundle protocols in cardiac surgery: a nine-year review of a regional cardiovascular center in China

Jufang Sun; Dewei Qian; Ren Zhou; Rong Tang; Lichun Guan; Yizhou Ye; Ying Pu; Min Yu

doi:10.21037/jtd-22-591

Effects of preoperative Staphylococcus aureus screening and targeted decolonization bundle protocols in cardiac surgery: a nine-year review of a regional cardiovascular center in China

J Thorac Dis. 2022 Dec;14(12):4741-4750. doi: 10.21037/jtd-22-591.

Authors

Jufang Sun^#¹, Dewei Qian^#², Ren Zhou³, Rong Tang⁴, Lichun Guan², Yizhou Ye², Ying Pu¹, Min Yu²

Affiliations

¹ Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Microbiological laboratory, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

^# Contributed equally.

Abstract

Background: Nosocomial infection (NI) prolongs hospital stay and heightens mortality among patients who underwent cardiac surgery. We constructed a retrospective study to explore the prevalence of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (SA/MRSA) nasal colonization, as well as the effects of SA/MRSA decolonization bundle measures on SA/MRSA-related infection among Chinese cardiac patients.

Methods: After reviewing the medical records, we divided cardiovascular surgery patients treated at our central campus into two groups: the baseline group (treated between January 2012 and December 2013) and the intervention group (treated between May 2014 and December 2020). Intervention measures consisted of preoperative nasal screening and targeted decolonization bundle therapy. The medical records of patients at our southern campus (treated between January 2017 and December 2020) were collected as an additional control group, since we did not implement SA intervention measures at this location. The incidences of SA/MRSA-related NI were then compared between the groups.

Results: There were 794 patients in the baseline group and 2,826 in the intervention group. A total of 131 (4.6%) patients had SA nasal colonization, and among them, 33 patients (1.2%) were MRSA colonized. SA/MRSA was cleared in approximately 95% of the carriers. The total level of SA-related infection was significantly lower in the intervention group compared to the baseline group [0.354% vs. 1.133%, respectively; P=0.021; risk ratio (RR): 0.312; 95% confidence interval (CI): 0.127-0.766]. The incidence of MRSA-related infection followed the same trend (0.212% vs. 0.756%, respectively; P=0.030; RR: 0.281; 95% CI: 0.091-0.860). When compared to the southern campus, SA intervention measures at the central campus resulted in a significant reduction in total SA-related infection (1.132% vs. 0.284%, respectively; P=0.035; RR: 0.251; 95% CI: 0.077-0.820).

Conclusions: The prevalence of SA/MRSA colonization is relatively low among Chinese patients who received cardiovascular surgery. Targeted decolonization bundle therapy was associated with cleared colonization and reduced incidence of SA/MRSA-related infection.

Keywords: Nosocomial infection (NI); Staphylococcus aureus (SA); colonization; decolonization; methicillin-resistant Staphylococcus aureus (MRSA).