Comparison of Nasal S. aureus Carriage in Solid Organ Transplant Recipients with Other Surgical Cases and Healthy Individuals

Year 2019, , 160 - 165, 01.04.2019

Derya Bayirli Turan , Ozden Ozgun Tuba Kuruoglu Kivanc Serefhanoglu

https://doi.org/10.5455/umj.20190325124138

Abstract

Background: Nasal S. aureus carriage NSAC increases the risk of wound infection, especially in surgery. In our study, we aimed to compare nasal S. aureus carriage in patients who were planned to undergo solid organ transplantation with patients applied for other surgery and healthy individuals who applied for job. Materials and Methods: Nasal swab cultures of 1425 participants consisting of 433 solid organ transplant patients and 791 other surgery patients who admitted to our tertiary care hospital between 2016-2018 and 201 healthy individuals were included in the study. Nasal swab specimens were cultured by using 5% sheep blood agar reduction method and incubated. The isolates were identified by conventional methods and antibiotic susceptibility tests were performed by disk-diffusion method. Results: S. aureus growth was detected in 283 19.85% of the cultures, and 8.48% of them were methicillin resistant S.aureus MRSA . NSAC rate was 20.78% in solid organ transplant recipients, 19.6% in other surgical patients, and 15.9% in healthy individuals. There was no statistically significant difference between groups in terms of S. aureus carriage p=0.315 . NSAC rate was 20.35% in all patients who were planned for any surgery, and there was no statistically significant difference in the carriage of S. aureus between the patients who underwent surgery and those who applied for job p=0.131 . There was no statistically significant difference between these groups in terms of MRSA carriage p=0.473 . Conclusion: In our study, methicillin-susceptible S. aureus colonization in the community was found to be high in both patients who were planned for surgery and in healthy individuals. Patients undergoing surgery are at greater risk for NSAC. We suggest that screening for S. aureus carriage preoperatively and decolonization in the presence of carriage may decrease the incidence of S. aureus infections in patients who are planned for surgery.

Keywords

Staphylococcus aureus, MRSA, nasal carriage, solid organ tumor, surgery.

References

• 1.Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751-762
• 2. Ippolito G, Leone S, Lauria FN, Nicastri E, Wenzel RP. Methicillin-resistant Staphylococcus aureus: the superbug. Int J Infect Dis 2010;14:7-11
• 3.Gemmell C, Edwards DI, Fraise AP, Gould FK, Ridgway GL, et al. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother 2006;57: 589-608
• 4.Wardvogel FA. Staphylococcus aureus (including toxic shock syndrom). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. Livingstone: USA; 2015. pp. 1757.
• 5. Yano K, Minoda Y, Sakawa A, Kuwano Y, Kondo K, et al. Positive nasal culture of methicillin-resistant Staphylococcus aureus is a risk factor for surgical site infection in orthopedics. Acta Orthopaedica 2009;80:486- 490
• 6. Taylor MD, Napolitano LM. Methicillin-resistant Staphylococcus aureus infections in vascular surgery: increasing prevalence. Surg Infec 2004;5:180-187
• 7.Olsen K, Sangvik M, Simonsen GS, Sollid JUE, Sundsfjord A, Thune I, et al. Prevalence and population structure of Staphylococcus aureus nasal carriage in healthcare workers in a general population. The Tromsø Staph and Skin Study. Epidemiol Infect 2013;141: 143-152
• 8.Aykut Arca E, Karabiber N, Sen S. Investigation of Staphylococcus aureus in pre-operative nasal cultures. Türk Hij Den Biyol Derg 2007;64: 23-26
• 9.Aydin M, Yazici S. Investigation of Nasal Staphylococcus aureus carriage at hospital staff. Ankara Üniversitesi Tip Fakültesi Mecmuasi 2012;65:1
• 10.Yagmur G, Melek I. Investigation of nasal carriage and antibiotic susceptibility of Staphylococcus aureus in healthcare staff. Journal of Harran University Medical Faculty. 2015;12: 31-37
• 11.Kökoglu ÖF, Geyuk MF, Ayaz C, Ucmak H, Hosoglu S. Investigation of nasal carriage rates and antimicrobial susceptibility of Staphylococcus aureus in health-care workers and hemodialysis patients in dicle university hospital. Turk J Infect. 2003;17: 443-446
• 12.Naz H, Cevik FC, Aykin N. Nasal Staphylococcus aureus carriage among hospital staff in Eskişehir Yunus Emre State Hospital. Ankem Derg 2006;20:141-144
• 13.Kurtoglu MG, Güzelant A, Kaya M, Kesli R, Baysal B. Staphylococcus aureus: nasal colonization, antimicrobial susceptibility and the effect of mupirosin in medical care workers Turk J Infect 2009;23:127-131
• 14.Bozkurt H, Bayram Y, Güdücüoglu H, Berktas M. Investigation of resistance rates to methicillin with nasal Staphylococcus aureus carrige at staff of Y.Y.Ü. Medical Faculty Research Hospital. Van Tip Derg 2007;14:52-56
• 15.Alim A, Artan OA, Atas M, Kalkan H, Madak S. Nasal carriage rate of Staphylococcus aureus in individuals participating in the routine carrier inspection process in Sivas. Flora 2012;17:202-205
• 16.Marım F, Taban Ö, Ergin C. Investigation of nasal Staphylococcus aureus carriage in Pamukkale University Health, Research and Training Center. Pam Tip Derg 2009;2: 20-23
• 17.Gündüz T, Akgül S. Nasal Staphylococcus aureus carriage in hospital staff. Türk Mikrobiyol Cem Derg 2004;34:220- 223
• 18.Kurutepe S, Gaz H, Sürücüoglu S, Aktas E, Özbakkaloglu B. Nasal carriage rates of methicillin-resistant Staphylo coccus aureus in clinical and pre-clinical hospital staff. Türk Mikrobiyol Cem Derg 2005;35:178-182
• 19.Ulug M, Ayaz C, Celen MK. The evaluation of Staphylo cocci strains isolated from nasal and bone cultures in patients with chronic osteomyelitis. Dicle Med J 2012;39: 339-343
• 20.Ulug M.Investigation of Nasal Staphylococcus aureus Carriage in Intensive Care Unit and Operating Room Staff. Med Bull Haseki The Medical Bulletin of Haseki 2012; 50: 48-52
• 21.Çelik G, Gülcan A. Hemodiyaliz tedavisi alan hastalarda nazal Staphylococcus aureus taşıyıcılığı ve risk faktörlerinin belirlenmesi. Türk Mikrobiyoloji Cem Derg 2010;40: 79-86
• 22.Çifci A, Biberoğlu S, Tosun İ, Cesur S, Gençtürk Z, İnal S, Ergen E. The rate and risk factors of nasal Staphylococcus aureus carriage in hemodialysis patients. Turk J Clin Lab 2016:7(4): 94-98
• 23.Kurutepe S, Ecemiş T, Sürücüoğlu S, Kürşat S, özbakkaloğlu B. Hemodiyaliz hastalarında Staphylococcus aureus burun taşıyıcılığı ve suşların antibiyotik direnci. Ankem Derg 2005;19:88-91
• 24.Weiser MC, Moucha CS. The current state of screening and decolonization for the prevention of Staphylococcus aureus surgical site infection after total hip and knee arthroplasty. J Bone Joint Surg Am 2015;97:1449-1458
• 25.Price CS, Williams A, Philips G, Dayton M, Smith W, et al. Staphylococcus aureus nasal colonization in preoperative orthopaedic outpatients. Clin Orthop Relat Res 2008;466: 2842-2847
• 26.Bert F, Galdbart JO, Zarrouk V, Me´e JL, Durand F, Mentre´F, et al. Association between Nasal Carriage of Staphylococcus aureus and Infection in Liver Transplant Recipients. Clinical Infectious Diseases 2000;31:1295–9
• 27.Abbasi S, Rostami S, Khorvash F, Shokri D, Khomarbaghi N and Ebrahimi N. Colonization With Methicillin-Resistant Staphylococcus aureus Upon Intensive Care Unit Admission: Incidence and Risk Factors,Avicenna J Clin Microb Infec. 2016 August; 3(3):e38217
• 28.Sollid JUE,. Furberg AS, Hanssen AM, Johannessen M. Staphylococcus aureus: Determinants of human carriage. Infection, Genetics and Evolution 21;2014 531–541
• 29.Von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344:11-16
• 30.Web page [02/02/2019] http://www.sağlıkturizmi.org.tr/tr /saglik-turizmi/genel-bilgi.html
• 31.Devkaran S, O’Farrell PN. The impact of hospital accreditation on clinical documentation compliance: a life cycle explanation using interrupted time series analysis. BM Open 2014;4:e005240.
• 32.Devkaran S, O’Farrell PN. The impact of hospital accreditation on quality measures: an interrupted time series analysis. BMC Health Serv Res 2015;15:137