Resident Geisinger Health System Danville, Pennsylvania, United States
Introduction: Staphylococcus aureus is the foremost bacterial cause of surgical site infection (SSI) and is a common source of neuromodulation SSI. Endogenous colonization is an independent risk factor for SSI, however, this risk has been shown to diminish with screening and decolonization. We aimed to evaluate the effectiveness of pre-operative S.aureus nasal swabbing and/or decolonization on SSI through a systematic review and meta-analysis of the literature.
Methods: A systematic review was performed according to PRISMA guidelines using the PubMed and Embase databases from inception to January 1, 2022 for the purposes of identifying all studies reporting on the use of S.aureus swabbing and/or decolonization prior to neuromodulation procedures. A random-effects meta-analysis was performed using the metaphor package in R to calculate log odds ratios (OR).
Results: In total, five observational cohort studies were included after applying inclusion and exclusion criteria. The average study duration was 6.6±3.8 years. Three studies included nasal screening as a prerequisite for subsequent decolonization. Type of neuromodulation included spinal cord stimulation in two studies, deep brain stimulation in two studies, intrathecal baclofen in one study and sacral neuromodulation in one study. Overall, 860 and 1054 patients were included in a control or intervention (i.e. screening and/or decolonization) group respectively. A combination of nasal mupirocin ointment and a body wash, most commonly chlorhexidine gluconate soap, were used to decolonize throughout. Overall infection rates were observed at 59/860 (6.86%) and 10/1054 (0.95%) in the control and intervention groups respectively. Four studies reported a significant difference. The log OR for intervention (screen and/or decolonization) versus no intervention was -1.68 (95% CI -2.37,-0.98; p< 0.001). Heterogeneity between studies was nonsignificant (I2 = 0%, τ2 = 0.00).
Conclusion : S. aureus swabbing and decolonization resulted in significantly decreased infection rates in neuromodulation procedures. This measure may represent a worthwhile tool to reduce neuromodulation SSI.
