Relationship between methicillin-resistant Staphylococcus aureus nasal carriage and surgical site infection after hepatectomy.

Matsushita, Katsunori; Shimizu, Junzo; Nakashima, Shinsuke; Ozato, Yuki; Noma, Toshiki; Hagihara, Kiyotaka; Shinno, Naoki; Suzuki, Yozo et al. · Surgery · 2026

retrospective_cohort · Level III

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Abstract

Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with an increased risk of postoperative surgical site infection. However, there are no definitive recommendations regarding preoperative methicillin-resistant Staphylococcus aureus screening or decolonization protocols in patients undergoing hepatectomy. This study investigated the relationship between nasal methicillin-resistant Staphylococcus aureus carriage and postoperative methicillin-resistant Staphylococcus aureus-related surgical site infections following hepatectomy. This retrospective cohort study included 603 consecutive patients who underwent hepatectomy between January 2011 and December 2025, classified into methicillin-resistant Staphylococcus aureus-positive and -negative groups based on nasal polymerase chain reaction results. Between-group incidence of surgical site infections and postoperative methicillin-resistant Staphylococcus aureus infections was compared. Methicillin-resistant Staphylococcus aureus nasal carriage was identified in 33 patients (5.5%). The incidence of surgical site infections was 30.3% and 13.0% in the methicillin-resistant Staphylococcus aureus-positive and -negative groups (P = .016). Among surgical site infection cases, the frequency of methicillin-resistant Staphylococcus aureus infection was significantly higher in the methicillin-resistant Staphylococcus aureus-positive group (70.0%) than in the methicillin-resistant Staphylococcus aureus-negative group (2.7%) (P < .001). Nasal methicillin-resistant Staphylococcus aureus colonization was associated with an increased risk of postoperative surgical site infection-overall and methicillin-resistant Staphylococcus aureus related-following hepatectomy. Targeted preoperative screening may help reduce the incidence of methicillin-resistant Staphylococcus aureus surgical site infections in this patient population.