Methicillin-Resistant Staphylococcus aureus Screening for Urogynecologic Mesh Procedures

Objectives: To determine the rate of positive methicillin-resistant Staphylococcus aureus (MRSA) screening and postoperative MRSA surgical site infections (SSI) in patients undergoing urogynecologic mesh procedures.

Methods: This was a retrospective cohort study utilizing the TriNetX database. TriNetX is a large, de-identified health research network with data sourced from 76 healthcare organizations. Patients were included if they underwent a sacrocolpopexy or midurethral synthetic sling between 2015-2022. The primary outcome was the rate of infectious complications between groups. Procedures, comorbidities within 1 year prior, and postoperative complications within 90 days were identified using CPT and ICD-10 codes. Patients were grouped into “screened” and “not screened” groups based on the presence of a MRSA swab within 90 days of the index surgery. Screened patients were further subdivided into “treated” and “not treated” based on receiving mupirocin or chlorhexidine in the same time period, with the presumption that the treated group had positive MRSA screening. Independent t-tests and chi-square tests were performed for continuous and categorical variables, respectively. Outcomes were compared with odds ratios (OR) and 95% confidence intervals (95% CI). All tests were two-tailed with an alpha level of .05.

Results: A total of 48,642 patients were identified, 47,989 did not have a MRSA screening swab while 653 did. Of those who were screened, 53 underwent treatment for MRSA and 598 were not treated, giving a screening positivity rate of 8.1%. The screened group had higher rates of MRSA infection (1.5% vs 0%, p< 0.001). There were no differences in superficial incisional, deep incisional, or organ space SSI between the screened and not screened groups, and between the treated and not treated groups. MRSA screening was associated with a higher risk of postoperative MRSA infection (OR 9.68, 95%CI 4.98-18.79) and abscess formation (OR 3.73, 95%CI 1.97-7.08). Treatment for MRSA was associated with a higher risk of postoperative MRSA infection (OR 13.67, 95%CI 5.40-34.64).

Conclusions: MRSA screenings are performed infrequently in patients undergoing urogynecologic mesh procedures. Infectious complications are rare and there may be low utility in universal MRSA screening in these patients.