Nasal carriage of Staphylococcus aureus: the key to preventing staphylococcal disease

Postoperative infections (Pis) are serious complications of thoracic surgery. To gain insight into the nature and the scope of the problem, an 18 month prospective surveillance was conducted at the department of thoracic surgery of the University Hospital Rotterdam, Dijkzigt. Pis were classified according to CDC criteria. One hundred and ninety-four out of 983 patients (19.7%) developed one or more Pis and in these 194 patients, 268 Pis were diagnosed. The incidence of Pis was 2.0 per 100 days of postoperative stay. The mean postoperative length of stay (LOS) of the 194 patients with Pis was 14.1 days longer than those without Pis. Deep surgical wound infections (DSWls) were associated with the longest prolongation of the median postoperative LOS in the hospital (30 days longer). Although lower than DSWls, incisional surgical wound infections also had a significant prolongation of stay (median 10 days longer). Staphylococcus aureus was the most important pathogen associated with surgical wound infections (SWls). Phage typing of 29 strains causing SWI showed only two identical pairs, so only a minority of infections could be explained by crossinfection. Older age, and more complicated procedures (e.g. cardiac valve operations) were independent, statistically significant risk factors for the development of Pis. Since there is a progressive trend towards operating on older patients and performing more complicated procedures, the incidence of Pis is expected to increase. Therefore it will become increasingly important to develop new strategies to prevent these serious complications.

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