{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T16:21:07Z","timestamp":1794327667577,"version":"4.9.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,17]]},"abstract":"\n OBJECTIVE<\/jats:title>\n \n Evidence suggests that preoperative\n Staphylococcus aureus<\/jats:italic>\n colonization predicts postoperative superficial surgical site infection (SSI). However, it is unclear how preoperative colonization is related to deep surgical site, organ space, and bloodstream infections after spine surgery. Therefore, the objective of this study was to investigate associations between preoperative\n S. aureus<\/jats:italic>\n colonization and\n S. aureus<\/jats:italic>\n infections following elective, instrumented posterior spine surgery.\n <\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n The authors retrospectively analyzed international trial data from 3311 participants who underwent open, instrumented, multilevel posterior spine surgery from 2015 to 2019. Multivariate logistic regression was used to determine associations between preoperative\n S. aureus<\/jats:italic>\n colonization and postoperative\n S. aureus<\/jats:italic>\n infection.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Thirty-five percent of participants (n = 1148) had preoperative\n S. aureus<\/jats:italic>\n colonization in the nose or throat. Within 3 months after surgery, 68 of all participants (2%) developed\n S. aureus<\/jats:italic>\n infections. Preoperative colonization was associated with greater odds of superficial SSI (OR 1.7, 95% CI 1.2\u20132.3; p = 0.004) and bloodstream infection (OR 1.8, 95% CI 1.1\u20134.2; p = 0.017). Other factors associated with postoperative infection included nasal (relative to throat) colonization (OR 1.03, 95% CI 1.01\u20131.1; p = 0.038), number of vertebrae fused (OR 1.2, 95% CI 1.1\u20131.2; p < 0.001), and BMI (OR 1.1, 95% CI 1.03\u20131.1; p < 0.001). Prophylactic decolonization was associated with lower odds of infection (OR 0.6, 95% CI 0.42\u20130.84; p = 0.003). Specifically, the odds were lower for participants treated with chlorhexidine wash (OR 0.4, 95% CI 0.25\u20130.64; p < 0.001), intranasal mupirocin (OR 0.13, 95% CI 0.02\u20130.98; p = 0.048), or both (OR 0.56, 95% CI 0.33\u20130.98; p = 0.041).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n \n Preoperative\n S. aureus<\/jats:italic>\n colonization was associated with superficial SSI and bloodstream\n S. aureus<\/jats:italic>\n infections after elective spine surgery. Prophylactic decolonization measures were associated with lower odds of postoperative infection. Future analysis should explore optimal decolonization regimens for at-risk individuals.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.12.spine25788","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T16:11:30Z","timestamp":1776442290000},"page":"126-131","source":"Crossref","is-referenced-by-count":0,"title":["Staphylococcus aureus colonization before elective posterior spine surgery: is it associated with postoperative S. aureus infections?"],"prefix":"10.3171","volume":"45","author":[{"given":"Aditya S.","family":"Joshi","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel S.","family":"Bronheim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan M.","family":"Schiedo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan A.","family":"Helbing","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Botolin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled M.","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Hassanzadeh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Int J Surg","first-page":"238","article-title":"Staphylococcus aureus, the major pathogen in orthopaedic and cardiac surgical site infections: a literature review","volume":"6","author":"Saadatian-Elahi M","year":"2008","unstructured":"Saadatian-Elahi M, Teyssou R, Vanhems P. Staphylococcus aureus, the major pathogen in orthopaedic and cardiac surgical site infections: a literature review. Int J Surg. 2008;6(3):238\u2013245. doi:10.1016\/j.ijsu.2007.05.001"},{"issue":"10","key":"b2","series-title":"Eur Spine J","first-page":"2543","article-title":"Does Staphylococcus aureus nasal decontamination affect the rate of early surgical site infection in adolescent idiopathic scoliosis surgery?","volume":"27","author":"Mallet C","year":"2018","unstructured":"Mallet C, Caseris M, Doit C, Does Staphylococcus aureus nasal decontamination affect the rate of early surgical site infection in adolescent idiopathic scoliosis surgery? Eur Spine J. 2018;27(10):2543\u20132549. doi:10.1007\/s00586-018-5744-4"},{"issue":"2","key":"b3","series-title":"Braz J Med Biol Res","first-page":"e6736","article-title":"Effectiveness of preoperative decolonization with nasal povidone iodine in Chinese patients undergoing elective orthopedic surgery: a prospective cross-sectional study","volume":"51","author":"Peng HM","year":"2017","unstructured":"Peng HM, Wang LC, Zhai JL, Weng XS, Feng B, Wang W. Effectiveness of preoperative decolonization with nasal povidone iodine in Chinese patients undergoing elective orthopedic surgery: a prospective cross-sectional study. 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