Our systematic review has identified important gaps in the literature on targeted decolonization strategies in Staphylococcus aureus carriers with different types of surgery. The overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination.
In an early meta-analysis of two randomized trials in cardiac surgery patients, limited by the number of studies, the results showed that no clear difference in SSI risk following the use of mupirocin compared with placebo (RR 1.60, 95%CI 0.79 to 3.25)9 25. Moreover, a recent meta-analysis32 reported that nasal MRSA colonization may be associated with increased risks of overall SSI and MRSA-SSI after spine surgeries through seven studies (RR = 2.52 and 6.21, respectively, both p < .001). Furthermore, a prospective, randomized, single-blinded trial, mentioned about SSIs after elective orthopedic surgery, found that no difference in the risk of SSI between the decolonization and control groups in 1318 patients, both in S. aureus carriers and non-carriers33. In light of this, more high-quality trials are needed to help to articulate the relationships among them.
Trojan Horse 34claimed a hypothesis trying to explain SSI pathogenesis, showing that pathogens remote from the SSI area—such as within the teeth, noses, or gastrointestinal tract—can be taken up by immune cells (macrophages or neutrophils) and travel to the wound site where they cause wound infections. This mechanism could be verified in a mice model, which can also explain why some infections occur latently following surgery and are due to organisms not found in the wound at the end of the operation6 35.
Several limitations derived from this systematic review must be acknowledged. First, the number of included randomized studies was small, which prevented us from evaluating the potential influences of strains of S. aureus (e.g hospital-associated MRSA/MSSA, community-associated MRSA/MSSA) or procedure characteristics (different types of eradicating measures) on the association between nasal S. aureus colonization and SSI events. Second, the adverse effects of decolonization (e.g increased risk of drug resistance) had been merely mentioned, which is significant for an appliance.
To conclude, the main pillars of from available evidence, it seems that nasal decontamination may be associated with a reduction of overall SSI and patients with pulmonary surgery. Further studies are needed to validate and propose the specific relationships between host and infection.