Benjamin Bouyer1, Robin Arvieu2, Marie-Paule Gerlinger3, Laurence Watier4, Najiby Kassis5, Simone Nerome6, Aziz Diop7, Jean-Luc Mainardi3, Pierre Durieux8, Pierre Guigui2. 1. Service d'orthopédie-traumatologie, hôpital européen Georges-Pompidou, Paris, France; Service d'orthopédie-traumatologie, hôpital européen Georges-Pompidou, université Paris-Descartes, Paris, France. Electronic address: benjamin.bouyer@aphp.fr. 2. Service d'orthopédie-traumatologie, hôpital européen Georges-Pompidou, Paris, France; Service d'orthopédie-traumatologie, hôpital européen Georges-Pompidou, université Paris-Descartes, Paris, France. 3. Service d'orthopédie-traumatologie, hôpital européen Georges-Pompidou, université Paris-Descartes, Paris, France; Unité de microbiologie clinique, hôpital européen Georges-Pompidou, université Paris-Descartes, Paris, France. 4. Inserm, UMR 1181 biostatistique, biomathématique, pharmacoépidémiologie et maladies infectieuses (B2PHI), Institut Pasteur, université Versailles Saint-Quentin-en-Yvelines, Saint Quentin en Yvelines, France. 5. Service d'orthopédie-traumatologie, hôpital européen Georges-Pompidou, université Paris-Descartes, Paris, France; Inserm, UMR 1181 biostatistique, biomathématique, pharmacoépidémiologie et maladies infectieuses (B2PHI), Institut Pasteur, université Versailles Saint-Quentin-en-Yvelines, Saint Quentin en Yvelines, France. 6. Unité d'hygiène et de lutte contre les infections nosocomiales, hôpital Beaujon, Paris, France; Service d'informatique médicale, hôpital Beaujon, université Paris Diderot, Paris, France. 7. Université Paris Diderot, Paris, France; Service d'informatique médicale, hôpital Beaujon, université Paris Diderot, Paris, France. 8. Service d'informatique médicale, hôpital Beaujon, université Paris Diderot, Paris, France; Service d'informatique médicale, hôpital européen Georges-Pompidou, université Paris-Descartes, Paris, France.
Abstract
BACKGROUND: In spinal surgery, incidence of surgical site infections (SSI) is estimated between 1 and 10%. It results in increased morbidity, mortality and cost of management. Individual Staphylococcus aureus (SA) decolonization has already proved efficiency to prevent those events in various surgical domains. The aim of this study was to evaluate a strategy of prevention of SSI and in particular the decolonization of the nasal carriage of SA by a protocol with Mupirocin application. METHODS: We conducted a bicentric observational study on 5314 spinal surgery patients over a seven-year period. In both center, we compared periods before and after implementation of two measures: modification of antibioprophylaxis and staphylococcus decolonization. Homogeneity of the different samples of patients was assessed through measure of individual and surgical variables. We measured monthly incidence of SSI and evaluated its evolution in order to assess efficiency of these interventions. RESULTS: The incidence of SSI decreased by half, from 7.3% to 3% at the Beaujon Hospital and from 8.3% to 3.9% at the Georges-Pompidou European Hospital (GPEH). We do not observe any significant decrease of SA rate in these SSI. CONCLUSION: We believe that Staphylococcus aureus decolonization should be recommended in spinal surgery, and should be combined with an overall improvement of the quality of care.
BACKGROUND: In spinal surgery, incidence of surgical site infections (SSI) is estimated between 1 and 10%. It results in increased morbidity, mortality and cost of management. Individual Staphylococcus aureus (SA) decolonization has already proved efficiency to prevent those events in various surgical domains. The aim of this study was to evaluate a strategy of prevention of SSI and in particular the decolonization of the nasal carriage of SA by a protocol with Mupirocin application. METHODS: We conducted a bicentric observational study on 5314 spinal surgery patients over a seven-year period. In both center, we compared periods before and after implementation of two measures: modification of antibioprophylaxis and staphylococcus decolonization. Homogeneity of the different samples of patients was assessed through measure of individual and surgical variables. We measured monthly incidence of SSI and evaluated its evolution in order to assess efficiency of these interventions. RESULTS: The incidence of SSI decreased by half, from 7.3% to 3% at the Beaujon Hospital and from 8.3% to 3.9% at the Georges-Pompidou European Hospital (GPEH). We do not observe any significant decrease of SA rate in these SSI. CONCLUSION: We believe that Staphylococcus aureus decolonization should be recommended in spinal surgery, and should be combined with an overall improvement of the quality of care.