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J Thorac Cardiovasc Surg 1996;112:681-686
© 1996 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

STERNAL WOUND INFECTION AFTER HEART OPERATIONS IN PEDIATRIC PATIENTS ASSOCIATED WITH NASAL CARRIAGE OF STAPHYLOCOCCUS AUREUS

Supported in part by grant no. 32-40884.94 from the Swiss National Foundation for Scientific Research to C.R.

Received for publication Nov. 28, 1995 Revisions requested Jan. 23, 1996; revisions received Feb. 14, 1996; Accepted for publication Feb. 15, 1996. Address for reprints: David Nadal, MD, Infectious Diseases Unit, University Children's Hospital, Steinwiesstrasse 75, 8032 Zürich, Switzerland.

Abstract

A cluster of six pediatric cases of deep-seated Staphylococcus aureus infection after heart operations prompted us to perform molecular typing of the S. aureus isolates by pulsed-field gel electrophoresis. This revealed the presence of genotypically distinct isolates in four of the six patients. Isolates of two patients were genotypically identical. All patients carried S. aureus in the anterior nares. In each patient, the banding pattern of deoxyribonucleic acid in these isolates was indistinguishable from that in strains isolated from blood or wound cultures. Molecular typing with pulsed-field gel electrophoresis ruled out nosocomial transmission of S. aureus between four patients; at the same time, it provided evidence for an association between nasal colonization and postoperative wound infection. Epidemiologic investigation of potential links between two patients with identical isolates did not provide any evidence for nosocomial transmission of S. aureus between these patients. Because nasal colonization with S. aureus may be a risk factor for surgical wound infection in pediatric patients undergoing heart operations, preoperative decolonization appears to be warranted. (J THORAC CARDIOVASC SURG 1996;112:681-6)

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