Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty

Abstract

ObjectiveThe aim of this study was to evaluate whether the establishment of a preoperative screening and decolonization protocol for Staphylococcus aureus carriers undergoing total knee arthroplasty (TKA) could decrease the incidence of periprosthetic joint infection (PJI) caused by this microorganism.MethodsWe conducted a retrospective study comparing a control group comprising 400 patients (134 men, and 266 women; mean age: 72.2 ± 6.8 years) who went through surgery between January 2009 and December 2013, with a second intervention group of 403 patients (125 men, and 278 women; mean age: 72.4 ± 6.9 years) in which the protocol of screening and decolonization of S. aureus nasal carriers was applied between January 2014 and December 2016. During this latter period patients were preoperatively screened and, if positive, treated with mupirocin nasal ointment and chlorhexidine soap, for 5 days prior to surgery.ResultsIn the control group, 17 of 400 patients (4.2%) had a SSI, 8 (2%) of them caused by S. aureus and 9 (2.2%) by other microorganisms. In the intervention group 20.6% of patients had a positive S. aureus nasal swab and were treated according to the protocol. 5 of 403 patients (1.2%) in this group had a SSI, 1 (0.2%) due to S. aureus and 4 (1%) to other microorganisms. When comparing surgical-site infection (SSI) rates between the two groups, we found a statistically significant reduction in both global SSI (p = 0.009) and specifically S. aureus SSI (p = 0.02), in the intervention group. No decolonized S. aureus nasal carrier presented a SSI.DiscussionIn patients undergoing TKA a preoperative screening and decolonization protocol for S. aureus nasal carriers, using mupirocin nasal ointment and chlorhexidine soap, is an effective measure to reduce the rate of SSI caused by this microorganism.Level of EvidenceLevel III; Therapeutic Study.

Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis

“…The remaining 46 fulltext papers were then retrieved for a more detailed analysis, of which 37 papers were excluded for several reasons, such as irrelevant research (n = 18), lacking raw date (n = 4) [18][19][20][21], containing revision or other [20][21][22][23][24][25][26][27][28][29][30][31][32][33], and inaccessible language (n = 2) [34,35]. Finally, a total of nine studies were included in this research [4,[10][11][12][13][36][37][38][39]. Six of them were performed multivariate analysis [10-13, 37, 38], and the remaining three studies were given a descriptive analysis of findings because of slightly different intervention methods [4,36,39].…”

“…A total of 36041 joint replacements were included in the nine studies, of which 26226 were divided into S. aureus screening and decolonization group, and the remaining 9815 were the control group. Except for one study that only included TKA [10], all other studies included TKA and THA [4,[11][12][13][36][37][38][39]. Among the nine studies, six were from the USA [4, 11-13, 37, 38], two from the UK [36,39], and one from Spain [10].…”

“…Except for one study that only included TKA [10], all other studies included TKA and THA [4,[11][12][13][36][37][38][39]. Among the nine studies, six were from the USA [4, 11-13, 37, 38], two from the UK [36,39], and one from Spain [10]. The longest follow-up period in these studies was 2 years [11], and the shortest follow-up time was 30 days [38], while it was difficult to find specific follow-up time in two studies [36,39].…”

“…The majority of studies included in this review used the diagnostic criteria of Center for Disease Control (CDC) and/or National Healthcare Safety Network (NHSN) for any wound complications [4,10,12,13,37], while Jeans et al [36] used the Public Health England's published standard, Sporer et al [38] diagnosed SSI based on clinical symptoms, positive wound culture, and a note in the medical record, while Rao et al [11] and Sankar et al [39] did not give a specific definition.…”

“…Some studies showed that the routine implementation of nasal screening and selective decolonization could significantly mitigate the risk of surgical site infection (SSI) following TJA [10][11][12][13]. However, it is still controversial, because several studies suggested the opposite conclusion [14,15].…”