Background Open-heart surgery improves heart function but carries a risk of serious postoperative infections, affecting up to 5% of patients. These infections lead to increased antibiotic use and contribute to antimicrobial resistance. Risk factors such as thoracic surgery, mechanical ventilation, and ICU admission elevate the likelihood of hospital-acquired respiratory tract infections. Targeted antimicrobial strategies aim to reduce these infections, thereby decreasing patient morbidity and mortality. Aim This study aimed to apply targeted methicillin-resistant Staphylococcus aureus (MRSA) skin and nasal decolonization protocols before open-heart surgery in a cardiac ICU and to assess their impact on reducing postoperative infections, morbidity and mortality rates. Patients and methods A prospective cohort study included 190 children, admitted to the Pediatric Cardiothoracic Surgery Unit at Cairo University, Specialized Pediatric Hospital. Cases are divided into two equal groups, the control group, which received routine preoperative disinfection, and the intervention group which received MRSA-targeted preoperative decolonization using chlorhexidine gluconate solution wash and intranasal topical mupirocin cream. Axillary and nasal swabs were conducted immediately before surgery, and both groups were studied postoperatively for incidence of infection and general outcome. Results Before surgery, the control group showed markedly higher bacterial colonization than the intervention group, which received preoperative decolonization with chlorhexidine gluconate solution wash and intranasal topical mupirocin cream. The overall rate of positive postoperative cultures was lower in the group that received preoperative decolonization compared with the control group. The reduction was most notable for wound infections, where isolates of coagulase-negative staphylococci and MRSA were significantly less frequent among intervention patients. Conclusion Preoperative targeted MRSA decolonization of the skin and nasal passages in pediatric cardiac surgery patients significantly reduced staphylococcal carriage immediately before surgery, decreased the incidence of staphylococcal contamination of surgical wounds postoperatively, and shortened ICU stay.
El-Sisi et al. (Thu,) studied this question.