Active Surveillance Screening of MRSA and Eradication of the Carrier State Decreases Surgical-Site Infections Caused by MRSA

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

“…2B) [5,9,16,19,42,51], the reduction of MRSA SSIs ranged from 29% to 149% (Fig. 2C) [9,29,36,40,49,57], and the reduction of wound complications was reported at 4% in one study [7]. Although all studies that were included showed reductions in SSIs with use of a decolonization protocol, not all reductions were statistically significant [20,26,29,36,49].…”

“…aureus detection was performed by PCR in four studies [5,19,30,40], culture in 13 studies [7,9,11,16,20,24,26,29,36,42,43,49,57], mixed methods of detection in one aggregate study [51], and unknown in one study [47]. Fifteen of the studies reported SSI reductions when only S. aureuspositive screened patients were decolonized, and eight studies [9,11,16,20,26,36,51,57] reported decreases in Table 2.…”

“…SSIs when all patients were decolonized. Regarding the method of decolonization, six studies exclusively used mupirocin [9,11,16,24,26,51], 10 used mupirocin and chlorhexidine [5,7,19,20,29,30,40,42,43,49], and three used mupirocin and triclosan [36,47,57] ( Table 2). The range of SSI reduction varied among groups; studies that used mupirocin showed only 29% to 57% reductions in total SSIs; studies that used mupirocin and chlorhexidine showed 13% to 81% reductions in total SSIs, 56% to 200% reductions in S. aureus SSIs, and 29% to 100% reductions in MRSA SSIs; and studies that used mupirocin and triclosan showed a 200% reduction in total SSIs and 56% to 149% reductions in MRSA SSIs.…”

“…Of the 19 studies that evaluated the ability of S. aureus screening and decolonization to reduce SSI in orthopaedic patients, there were nine prospective studies [5,26,30,42,43,47,49,51,57] and 10 retrospective studies [7,9,11,16,19,20,24,29,36,40] (Table 1). Most studies evaluating S. aureus screening and decolonization in orthopaedic patients were conducted on patients undergoing elective total joint arthroplasty [11,16,19,20,25,30,42,43,47,49], although many studies did evaluate all elective orthopaedic patients [5,9,24,29,36,40,51,57], spine patients [7,30], and trauma patients [36].…”

“…Most studies evaluating S. aureus screening and decolonization in orthopaedic patients were conducted on patients undergoing elective total joint arthroplasty [11,16,19,20,25,30,42,43,47,49], although many studies did evaluate all elective orthopaedic patients [5,9,24,29,36,40,51,57], spine patients [7,30], and trauma patients [36]. The majority of studies detected S. aureus colonization using cultures, most SSIs were defined by CDC criteria, the majority of studies did not differentiate between superficial versus deep infections, and most of the patients who underwent decolonization were positive for S. aureus on nasal screens ( Table 2).…”