Do lower respiratory tract samples contribute to the assessment of carriage of <i>Staphylococcus aureus</i> in patients undergoing mechanical ventilation after major heart surgery?

Colonization by Staphylococcus aureus is regularly assessed in patients undergoing major heart surgery (MHS). Despite pre-surgical decontamination attempts, a significant proportion of MHS patients remain colonized by S. aureus at the time of surgery. Nasal sampling can be improved by sampling extra-nasal areas. We evaluated whether processing lower respiratory tract (LRT) secretions enhanced the detection of S. aureus after MHS. Following a standard protocol, nasal swabs and LRT aspirates were obtained from all of the study patients at the time of surgery or in the immediate postoperative period. One swab was used for culture in the microbiology laboratory, and a second swab was used for the Xpert SA Nasal Complete assay. According to our definition of colonization (culture positive and/or PCR positive), 31 of 115 patients (26.9%) were colonized at the time of surgery. Among these, LRT samples only were positive in three patients (2.6% of the whole population and 9.7% of the carriers). The remaining 28 were either positive in the nasal sample or positive in both samples. The yield of the detection of colonization by S. aureus by including also LRT samples in patients undergoing MHS is limited and must be balanced with laboratory workload and demands on laboratory personnel.Trial registration: Clinical trials.gov NCT02640001.