ORLANDO Screening and treating methicillin-resistant Staphylococcus aureus nasal carriage in patients before Mohs surgery lowered postoperative MRSA infection rates, according to a new study.
A patient screening and decontamination protocol in the week before surgery brought the postoperative MRSA infection rate to zero. Before such a protocol was in place, the rate was 0.33%, Dr. Katharine Cordova, of Brown University, Providence, R.I., reported in a poster at the annual meeting of the American Society for Dermatologic Surgery.
The protocol screened all patients for nasal MRSA colonization during the preoperative consultation appointment. Patients previously treated with Mohs surgery and patients from the local Veterans Affairs hospital were not screened. Over an 11-month period, 963 nasal swabs were obtained, and 23 MRSA carriers were identified.
Carriers were treated preoperatively with intranasal mupirocin twice daily for 57 days and perioperatively with oral trimethoprim-sulfamethoxazole for 57 days starting 1 day before surgery.
Patients were also given chlorhexidine or chloroxylenol and cocamidopropyl PG-dimonium chloride phosphate (Techni-Care) body washes to be used the 5 days preceding surgery.
None of the patients developed a MRSA infection.
By mistake, one of the MRSA carriers was not given perioperative treatment. The patient subsequently developed a MRSA wound infection.
Dr. Cordova acknowledged that such a screening program is costly, especially because the incidence of MRSA infections after Mohs surgery is very low. "A large number of negative swabs must be obtained in order to detect one MRSA carrier. At our institution, each negative nasal swab costs $63.00 and a positive screen requires confirmatory testing, which costs an additional $90.00," she said.
A practical approach would be to screen patients with prior MRSA infection or colonization, who are known to be at increased risk for repeat infections and complications, she suggested.
Dr. Cordova declared that she had no conflicts of interest relevant to her presentation.