BACKGROUND: Prior studies published in the cardiothoracic, orthopedic and 
gastrointestinal surgery have identified the importance of nasal 
(methicillin-resistant Staphylococcus aureus) MRSA screening and subsequent 
decolonization to reduce MRSA surgical site infection (SSI). This is the first 
study to date correlating nasal MRSA colonization with postoperative spinal MRSA 
SSI.
OBJECTIVE: To assess the significance of nasal MRSA colonization in the setting 
of MRSA SSI.
METHODS: A retrospective electronic chart review of patients from year 2011 to 
June 2013 was conducted for patients with both nasal MRSA colonization within 30 
days prior to spinal surgery. Patients who tested positive for MRSA were put on 
contact isolation protocol. None of these patients received topical antibiotics 
for decolonization of nasal MRSA.
RESULTS: A total of 519 patients were identified; 384 negative (74%), 110 
MSSA-positive (21.2%), and 25 (4.8%) MRSA-positive. Culture positive surgical 
site infection (SSI) was identified in 27 (5.2%) cases and was higher in 
MRSA-positive group than in MRSA-negative and MSSA-positive groups (12% vs. 
5.73% vs. 1.82%; p=0.01). The MRSA SSI rate was 0.96% (n=5). MRSA SSI developed 
in 8% of the MRSA-positive group as compared to only in 0.61% of MRSA-negative 
group, with a calculated odds ratio of 14.23 (p=0.02). In the presence of SSI, 
nasal MRSA colonization was associated with MRSA-positive wound culture (66.67 
vs. 12.5%; p<0.0001).
CONCLUSION: Preoperative nasal MRSA colonization is associated with 
postoperative spinal MRSA SSI. Preoperative screening and subsequent 
decolonization using topical antibiotics may help in decreasing the incidence of 
MRSA SSI after spine surgery. Nasal MRSA+ patients undergoing spinal surgery 
should be informed regarding their increased risk of developing surgical site 
infection.