Decolonization of Patients Carrying S. Aureus Before Cardiac Surgery: Study of the Risk Factors Associated With Failure

Study Overview
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Brief Summary
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Staphylococcus aureus nasal carriage is a well-known risk factor for S. aureus surgical site infections (SSI). According to a recent study demonstrating 60% reduction risk of SSI due this bacterium after patients' screening and decolonization, recent French and WHO guidelines recommend in cardiac surgery the decolonization of nasal S. aureus carriers before surgery. In practice the decolonization procedures are not well-defined according notably to the duration and time of delivery before surgery and doses of topical antimicrobial drugs. The aim of the proposed study is to investigate the factors associated with failures of S. aureus decolonization: carriage state, compliance with treatment, S. aureus capacity of internalization in nasal epithelial cells, resistance to antimicrobial drugs used. This study will allow (i) to measure the frequency of patients with residual S. aureus carriage just before surgery, whatever they have been decolonized or not, (ii) to characterize the S. aureus nasal carriage state of patients before surgery, and (iii) to investigate the adding value of mupirocin dosage in the nose and urines of decolonized patients as a marker of compliance and efficacy of the decolonization process.

Official Title
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Decolonization of Patients Carrying S. Aureus Before Cardiac Surgery: Study of the Risk Factors Associated With Failure

Conditions
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Staphylococcus Aureus

Intervention / Treatment
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* Procedure: decolonization
* Other: compliance questionnaire


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient to benefit from cardiac surgery scheduled at Saint-Etienne University Hospital Surgery of first intention (no resumption) Patient affiliated or entitled to a social security scheme Patient agreeing to participate in the study and having signed the informed consent Exclusion Criteria: Surgery in a context of infection Surgery in an emergency and semi-emergency context Protected major patient Pregnant

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| patients with failures of decolonization S. aureus<br>patients with failures of decolonization S. aureus in their nose | Procedure: decolonization<br>* current practice : V1 : consultation to the service : nasal sample for all 5 days before surgery : order sent with decolonization procedure : nasal mupirocin, shower and mouthwash V2 : admission to the service : nasal sample for all and urine sample for decolonized patients V3 : nasal sample for all<br>Other: compliance questionnaire<br>* We asked if the patient has done the whole decolonization procedure<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of participants with failure of decolonization of nasal carriers of S. aureus | These patients were screened positive for S. aureus in nasal swab culture collected during the preoperative consultation of cardiac surgery, who received a decolonization prescription and who are again detected positive in culture for S. aureus on the nasal collection performed on admission to the surgery department (just before surgery). | just before surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of nasal carriage of S. aureus just prior to cardiac surgery in all patients |  | before surgery | 
| Prevalence of nasal carriage of S. aureus 3 months after cardiac surgery in all patients |  | 3 months | 
| Correlation between nasal dosing of mupirocin and compliance |  | 3 months | 
| Correlation between mupirocin urine metabolite assay associated with mupirocin nasal dosing and decolonization efficacy (failure or not). |  | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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decolonization, mupirocin, cardiac surgery