Skin and mucous membranes colonisation with Staphylococcus aureus or MRSA as a risk factor for surgical site infections in elective Caesarean Section

Abstract

The purpose of this study was to determine if skin and mucous membrane colonisation with Staphylococcus aureus (S. aureus) and methicillin-resistant Staphylococcus aureus (MRSA) increases the incidence of surgical site infection (SSI) post-elective Caesarean Sections. A prospective study was conducted at a major centre in Jordan, involving 127 patients who underwent elective Caesarean Section surgeries during 2019. Participants were screened for skin and mucous membranes colonisation for S. aureus preoperatively and were followed for 90 days for any signs of SSI. The screening sites were on three parts of the patients’ bodies; nose, throat, and groyne. The total SSI incidence was 18.9%. Among participants with SSI; 66.7% had a superficial infection and 33.3% had deep tissue infection. Skin and mucous membrane colonisation was positive in 42 participants (33.1%) in one of the three screening sites. Participants with positive skin and mucous membrane colonisation were found to have SSI incidence 2.43 times more than the non-colonised participants (Fisher’s Exact test = 3.832, p = .05, CI: 0.098–6.02). Participants with S. aureus skin and mucous membranes colonisation were significantly 2.94 times with more SSI incidence than those who were not colonised (Fisher’s Exact test = 5.485, p = .02, CI: 1.164–7.439). Skin and mucous membrane colonisation was found to increase the incidence of SSI. More attention should be performed to screen for skin and mucous membranes colonisation and subsequent selective skin decolonisation to decrease SSI incidence.

IMPACT STATEMENT

• What is already known on this subject? Surgical site infection (SSI) is a challenge that increases the costs of health care. Surgical site infection is associated with high costs mainly due to the increase in the length of hospital stay. Skin screening for S. aureus or MRSA colonisation was found to be important for selective skin decolonisation using appropriate antiseptic preparation and preoperative antibiotic prophylaxis.

• What do the results of this study add? The incidence of SSI in the colonised group was found to be 2.43 times higher than in the non-colonised group.

• What are the implications of these findings for clinical practice and/or further research? Screening for colonisation and subsequent selective skin decolonisation should be a part of SSI prevention policies.

Keywords:

• Caesarean Sections
• infection
• skin and mucous membranes colonization
• surgery

Disclosure statement

The authors have no conflicts of interest to declare concerning this work.