Wednesday, April 17, 2013

Getting Beyond MRSA- Controlling MSSA Infections

Over the last several decades we have focused more on infections caused by methicillin resistant Staphylococcus aureus (MRSA) than methicillin susceptible Staphylococcus aureus.  The prevalence of MSSA at hospital admission is greater than MRSA. The risk of infection is higher in MRSA carriers versus MSSA. Regardless, MSSA infections are of consequence and epidemiologocally important.

Here is a thought provoking review article in the Journal of Hospital Infection on controlling MSSA infections. The paper neatly summarizes the current knowledge on staphylococcal carriage, microbiological strategies for screening, and the impact of MSSA decolonization on staphylococcal hospital acquired infections.

Recent studies suggest that MSSA decolonization reduces S.aureus surgical site infections.
Questions remain about the optimal screening strategy and the added value of throat and skin decolonization atop nasal mupirocin use. 

Where I work, our strategy is to MRSA screen patients undergoing elective surgeries in cardiothoracic, neurosurgery and orthopedic prosthetic joint implantation.  Patients who are MRSA colonized are decolonized with chlorehexidine and intranasal mupriocin and vancomycin is the perioperative antibiotic of choice. 

Although both are uncommon, MSSA infections exceed MRSA infections at my hospital.

Perhaps we should rethink this approach and add MSSA to the decolonization protocol.  

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