Pre-Operative Staphylococcal Screening for Patients Undergoing Ventral Hernia Repair: A Strategy to Reduce Post-Operative Infections. (4th October 2017)

• Record Type: Journal Article
• Authors: Tiwari, Yagya; Khameraj, Aradhana; Gadaleta, Dominick; Farber, Bruce
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S648
• Page End: S648
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.1725
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Staphylococcus aureus is a major pathogen responsible for surgical site infections. Ventral hernia repairs are one of the most commonly performed surgeries that usually require the use of mesh. Pre-operative nasal screening can help identify patients that are carriers for Staphylococcus. Treating such carriers pre-operatively may help reduce post-operative infections. Methods: Pre-operative screening for Staphylococcus was started in October 2015 at North Shore University Hospital. A retrospective review of all hernia repair surgeries 18 months prior (April 2014 to September 2015) and 18 months after (October 2015 to March 2017) the standard screening measures were instituted was performed. Only the patients with ventral hernia repairs (epigastric, incisional, umbilical, Spigelian and parastomal) were included. Patients in the pre-operative screening period positive for MRSA and MSSA were decolonized with intranasal mupirocin and chlorhexidine bath for 5 days before the surgery. The rates of post-operative infections were compared between these two groups using Chi-square test and also using a multivariable logistic regression, controlling for age and gender. Results: Of the 612 patients in the study sample, 240 (39.22%) underwent pre-operative screening and 372 (60.78%) did not. Patients were similar by age, sex and specialiaty across the groups. Among the pre-operative screening group, 29.58% ( n = 71) were positive for MSSA, MRSA or both. Of those, 25.35% ( n = 18) were positive for both MRSA/MSSA and 74.64% ( n = 53) were MSSA. The rate of post-operative infection was significantly lower in the screened group than in the non-screened group (1.67% ( n = 4) vs. 6.45% ( n = 24), P = 0.0057). In the logistic regression model, we found that those who were not screened were 4 times more likely to have a post-operative infection than those who were screened (OR=4.01, 95% CI=[1.37–11.71], P = 0.0102). Conclusion: Pre-operative screening for Staphylococcus is an effective strategy to reduce post-operative ventral hernia infections. Like cardiac and orthopedic operations, routine screening and treatment for MRSA/MSSA carriers will significantly reduce the risk of post-operative infections in patients undergoing repair of ventral hernias. Disclosures: All authors: No reported disclosures.