Risk of Surgical Site Infection in Elective Hip and Knee Replacements After Confirmed Eradication of MRSA in Chronic Carriers

Tandon, Tarang; Tadros, Baha John; Akehurst, Harold; Avasthi, Adhish; Hill, R. D.; Rao, Madhu

doi:10.1016/j.arth.2017.06.036

Cited by 13 publications

(8 citation statements)

References 41 publications

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“…The results of this study show that at our institution there is a 1.25% MRSA colonisation rate in patients undergoing total hip and knee arthroplasty. This is comparable with studies in the literature demonstrating rates by Tandon et al [ 8 ] of 1.3%.…”

Section: Discussionsupporting

confidence: 91%

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Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy

Kapur¹,

Tonge²,

Kumar³

2021

WJO

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BACKGROUND Prosthetic joint infection (PJI) is a devastating complication requiring prolonged treatment and multiple operations, leading to significant morbidity for the patient. Patients are routinely tested for methicillin-resistant staphylococcus aureus (MRSA) colonisation. MRSA positive patients are given eradication therapy. We hypothesise that patients who are MRSA positive pre-operatively, have increased risk of developing PJI. AIM To identify deep wound infection (PJI) rates in patients who are colonised MRSA positive compared with those who are not colonised; and long term clinical and radiological outcomes. METHODS All patients who underwent total hip and knee replacements (THR/TKR) between December 2009 and December 2019 were identified. Patients who were also identified as being MRSA positive at pre-operative assessment were then selected. Confirmation of prescribing eradication treatment was recorded. Patient records, including consultation letters, operation notes and microbiology results were reviewed retrospectively. Comparison of outcomes for each MRSA positive patient was made with 2 MRSA negative patients undergoing the same operation of a similar age by the same consultant. RESULTS Screening identified 42 knee and 32 hip arthroplasty patients as MRSA positive, 84 MRSA negative knee and 64 hip patients were reviewed. Patients were matched with medical co-morbidities in each group. Mean follow up was 5 years. PJI was identified in 4/32 (12.5%) of THR MRSA positive and 3/42 (7%) of TKR patients. All patients had PJI within one year of surgery. CONCLUSION MRSA positive patients are given eradication therapy routinely. However, no confirmation of eradication is sought. Patients who have MRSA colonisation pre-operatively, in our study had a significantly increased risk of PJI, when compared to negative patients. We would recommend establishing true eradication after treatment prior to arthroplasty.

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Section: Discussionsupporting

confidence: 91%

“…The centers of disease control recognised nasal colonisation as a risk factor for SSI[ 8 ]. As a result there has been a focus on pre-operative screening and decolonisation prior to the patient undergoing surgery.…”

Section: Introductionmentioning

confidence: 99%

Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy

Kapur¹,

Tonge²,

Kumar³

2021

WJO

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“…Elimination of S. aureus (MRSA) carriers from TJA surgery could contribute to reductions in PJI [57]; however, some patients may be carriers even after decontamination [67,68].…”

Section: Staphylococcal Decolonization (Nasal Skin)mentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

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“…Previous MRSA carriers who undergone successful decolonization and had confirmed eradication of MRSA still had a significantly higher risk of SSI when undergoing THA or TKA (total knee arthroplasty) compared with those who never tested positive for MRSA 78 .…”

Section: Risk Factorsmentioning

confidence: 99%

What’s New in Hip Replacement

Glassman

2018

The Journal of Bone and Joint Surgery

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Risk of Surgical Site Infection in Elective Hip and Knee Replacements After Confirmed Eradication of MRSA in Chronic Carriers

Cited by 13 publications

References 41 publications

Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy

Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

What’s New in Hip Replacement

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