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Staphylococcus aureus is a gram-positive bacterium that can commonly be found on the skin or in the nares of approximately 30% of the population without actively causing an infection, also known as colonization.1 Staphylococcus aureus can be susceptible to many antibiotics, including beta-lactams such as oxacillin and methicillin, at which point the S aureus would be referred to as "methicillin-susceptible S aureus (MSSA)." Staphylococcus aureus also can develop resistance to beta-lactams, at Which point it is referred to as "methicillin-resistant S aureus (MRSA)." Although far less common, S aureus can also be resistant to vancomycin, one of the main agents used to treat MRSA, at which point it would be referred to as "vancomycin-intermediate S aureus (VISA) or "vancomycin-resistant S aureus (VRSA)."1
Staphylococcus aureus transmission has long been a concern in all areas of health care since MRSA was first detected in 1961,2 and 5 aureus is an even greater concern in the surgical setting. In the most recent report from the Centers for Disease Control and Prevention's National Healthcare Safety Network in 2019, which reviewed data across the United States from 2015 to 2017, S aureus was the most common organism implicated in surgical site infections (5515), serving as the causative agent in 17.5% of all reported SSIs.3 This number was even more staggering in orthopedic and cardiac surgeries, with S aureus causing 38.6% of all reported orthopedic infections and 27% of all cardiac surgery infections.3 Although 5 aureus continues to cause a significant number of SSIs both in the United States and internationally, the best targeted infection prevention interventions have been debated in the literature.
One of the leading guidelines on SSI prevention is the ciety for Epidemiology of America (SHEA) and Infectious Disease Society of America (IDSA)'s Strategies to Prevention Surgical Site Infections in Acute Care Hospitals. In the 2014 updates to the SHEA/IDSA guidelines, screening for 5 aureus in orthopedic and cardiothoracic surgery patients and decolonizing those patients who screened positive was listed as moderate-quality evidence.4 In the 2022 update to the SHEA/IDSA guidelines, the level of evidence for decolonizing patients undergoing orthopedic and cardiothoracic procedures was upgraded to high-quality evidence, and was even added to the list of essential practices in their guidelines for SSI prevention.5
As the evidence continues...