Staphylococcus aureus Nasal Colonization in Preoperative Orthopaedic Outpatients

Abstract

Nasal colonization with Staphylococcus aureus (SA) increases the risk of surgical site infection (SSI). We first (1) determined the prevalence of asymptomatic nasal colonization with SA, (2) assessed trends in methicillin resistance with time, (3) ascertained risk factors for nasal colonization; and (4) correlated SSI to nasal colonization status and procedure. We performed a cross-sectional analysis of SA nasal colonization among healthy preoperative orthopaedic outpatients between 2003-2005 who were within 2 weeks of surgery. Of 284 patients, 86 (30%) carried SA; of these, 81 (94%) were colonized with methicillin-sensitive and five (6%) with methicillin-resistant SA (MRSA). Total SA colonization increased from 25/ 78 (32%) in 2003 to 37/97 (38%) in 2005, and colonization with MRSA increased from 0/78 (0%) to four of 97 (4%), respectively. We found no associations between nasal carriage and demographics or procedures. Surgical site infection occurred in nine of 282 (3%), four of which were attributable to SA; these included 0/43 (0%) carriers who received decolonization with 2% mupirocin, two of 43 (4.7%) who declined decolonization, and two of 196 (1.0%) who were noncarriers. Nasal colonization with SA, including MRSA, among preoperative orthopaedic outpatients is increasing and their rates reflect community rates. Knowledge of colonization status may be important in decolonization, choosing perioperative or any subsequent empiric antibiotics.

Does Insurance Type, Private Versus Public, Have a Correlation with MRSA Carrier Status In a Population Undergoing Orthopedic Surgery?

“…Estimates of MSSA carrier state range from 25 to 35% in the community [1,5] with MRSA rates estimated between 1 and 10% [1][2]8]. Similar colonization rates have been found in hospital and orthopaedic settings [14][15][16].…”

“…MSSA and MRSA are serious pathogens and their rates of colonization in the public are increasing [1,13]. Estimates of MSSA carrier state range from 25 to 35% in the community [1,5] with MRSA rates estimated between 1 and 10% [1][2]8].…”

“…Staphylococcus aureus (SA) is a well-documented agent of surgical site infection (SSI) in orthopaedic patients [1][2]. Preoperative nasal colonization with SA has been shown to be a strong risk factor for SSI, with carriers being two to nine times more likely than non-carriers to acquire SSI [1,[3][4][5][6].…”

“…Preoperative nasal colonization with SA has been shown to be a strong risk factor for SSI, with carriers being two to nine times more likely than non-carriers to acquire SSI [1,[3][4][5][6]. Methicillin-resistant SA (MRSA) infection provides particularly difficult complications following surgical procedures and has been documented to be twice as deadly as methicillin-sensitive SA (MSSA) in SSI [7,8].…”

“…SSI with MRSA has been linked to many adverse health outcomes and higher rates of complications in orthopaedic patients [7,8]. Given the seriousness of MRSA SSI complications, it is crucial to know patient colonization status preoperatively in order to provide appropriate perioperative treatment [1,8]. Notably, patient MRSA preoperative screening programs have been shown to significantly reduce SSI postoperatively by providing the opportunity for preoperative decolonization efforts and appropriate perioperative antibiotic prophylaxis to MRSA positive patients [2,10].…”