{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:35:38Z","timestamp":1791203738638,"version":"4.2.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surgical Infections"],"published-print":{"date-parts":[[2021,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Surgical site infections (SSIs) are recognized complications of surgical procedures. Methicillin-resistant\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      (MRSA) colonization increases the likelihood of developing SSIs. Decolonization of MRSA has been shown to reduce post-operative SSIs, therefore, the aim of this project was to identify and decolonize MRSA carriers and to tailor perioperative antibiotic prophylaxis to protect those at high risk for SSIs better.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In September 2013, a quality improvement process initiative was implemented for pre-operative screening of MRSA nasal carriage for patients undergoing elective neurosurgical procedures. Those identified as colonized received a 10-day decolonization protocol that consisted of: oral doxycycline 100\u2009mg twice daily or oral trimethoprim-sulfamethoxazole (TMP-SMX) DS twice daily; oral rifampin 600\u2009mg daily; daily bathing with chlorhexidine; and twice daily use of mupirocin ointment in each nostril and under the fingernails. In addition to cefazolin (weight-based dosing), vancomycin (weight-based dosing) was recommended for perioperative prophylaxis in known MRSA carriers and patients undergoing surgical procedures involving hardware implantation irrespective of colonization status. We compared the results with our previously documented neurosurgical site infection rates (2012 and 2013 were 3.0 and 2.2%, respectively)<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      From 2014 to 2015, MRSA screening was done for 1,197 patients, of whom 52 (4.3%) were found to be colonized. Surgical site infections occurred in 14 procedures (1.4%) in 2014 and eight (0.8%) procedures in 2015, respectively. Methicillin-resistant\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      remained responsible for most of these infections. None of the patients who underwent decolonization developed an infection (MRSA or otherwise).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The overall rate of neurosurgical site infections can be reduced through a bundled approach of MRSA decolonization and change in perioperative antibiotic prophylaxis to include vancomycin for procedures involving hardware implantation irrespective of MRSA carriage state.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/sur.2020.020","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T16:27:13Z","timestamp":1588609633000},"page":"217-221","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Comprehensive Approach to Reduce Surgical Site Infections in Patients Undergoing Neurosurgical Procedures"],"prefix":"10.1177","volume":"22","author":[{"given":"Ahmad Rakad","family":"Nusair","sequence":"first","affiliation":[{"name":"Medical Subspecialties Institute-Infectious Diseases, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wasim S.","family":"El Nekidy","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates."},{"name":"Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Cabell Huntington Hospital, Huntington, West Virginia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Evans","sequence":"additional","affiliation":[{"name":"Cabell Huntington Hospital, Huntington, West Virginia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rania","family":"El-Lababidi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Alatoom","sequence":"additional","affiliation":[{"name":"Pathology and Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2006.7.s1-7"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2011.05.056"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000166532.58227.4f"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3109\/02688697.2013.835376"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.10.SPINE14228"},{"key":"e_1_3_3_7_2","unstructured":"Centers for Disease Control and Prevention. National Healthcare Safety Network. Operational Guidance for Reporting Surgical Site Infection (SSI) Data to CDC's NHSN for the Purpose of Fulfilling CMS's Hospital Inpatient Quality Reporting (IQR) Program Requirements. November 2014. www.cdc.gov\/nhsn\/PDFs\/CMS\/Final-ACH-SSI-Guidance_2015.pdf (Last accessed December4 2017)."},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1086\/656591"},{"key":"e_1_3_3_9_2","first-page":"287","article-title":"Combined topical and oral antimicrobial therapy for the eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization in hospitalized patients","volume":"13","author":"Fung SK","year":"2002","unstructured":"Fung SK, , Louie M, , Simor AE. Combined topical and oral antimicrobial therapy for the eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization in hospitalized patients. Can J Infect Dis, 2002; 13:287\u2013292.","journal-title":"Can J Infect Dis"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir034"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3109\/02688697.2011.566384"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2013.9999"},{"key":"e_1_3_3_13_2","unstructured":"Centers for Diseases Control and Prevention. National Hospital Discharge Survey 2010. www.cdc.gov\/nchs\/data\/nhds\/4procedures\/2010pro_numberpercentage.pdf (Last accessed December4 2017)."},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1086\/664048"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2009.03.020"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2015.05.039"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1086\/646887"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1086\/432803"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2009.06.010"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1086\/533494"}],"container-title":["Surgical Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/sur.2020.020","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/sur.2020.020","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/sur.2020.020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T02:25:50Z","timestamp":1777688750000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/sur.2020.020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,11]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,3,1]]}},"alternative-id":["10.1089\/sur.2020.020"],"URL":"https:\/\/doi.org\/10.1089\/sur.2020.020","relation":{},"ISSN":["1096-2964","1557-8674"],"issn-type":[{"value":"1096-2964","type":"print"},{"value":"1557-8674","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,11]]}}}