Surgical site infection risk following pre-operative MRSA detection in elective orthopaedic surgery

Akhtar, Ahsan; Kadir, Haji Khairul Abd; Chandran, Prakash

doi:10.1016/j.jor.2014.07.001

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…In a 2014 study, 0.9% of 11,567 elective orthopaedic patients were MRSA colonized with 3.45% of patients undergoing surgery developing postoperative sepsis. 11 Their study demonstrated a similar population size with similar MRSA prevalence but lower rates of surgical infection. This is possibly reflective of lower presurgical infection risk in patients with greater physiological reserve.…”

Section: Discussionmentioning

confidence: 78%

Experience with Methicillin-Resistant Staphylococcus aureus in a Central London Tertiary Pediatric Hospital

Chahal¹,

Omran²,

Vora

et al. 2022

J Pediatr Infect Dis

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Objective Methicillin-resistant Staphylococcus aureus (MRSA) infection is very serious, and thus, it is common practice, worldwide, to screen for MRSA colonization at admission and institute decolonization procedures. Our aim was to review adherence to local guidelines and sepsis risk in pediatric patients with a focus on surgical cases. Methods A retrospective case note review was conducted from January 2019 to October 2020 in a tertiary pediatric hospital. Data collected included demographics, incidence of sepsis, pediatric intensive care unit (PICU) admissions, and adherence to guidelines. The results were analyzed with an SPSS statistical package. Results MRSA screening was performed in all 47,904 admissions; 161/47,904 had MRSA colonization. All underwent topical decontamination; however, isolation guidelines were adhered in only 7.45%; 71/161 were surgical patients; 23/71 were admitted to the PICU. Irrespective of the class of wound, 4/71 surgical patients developed MRSA sepsis. Of these, 2/5 surgical patients did not receive MRSA appropriate preoperative antibiotics; 4/5 surgical patients who had sepsis were admitted to PICU. Standard preoperative World Health Organization (WHO) surgical checklists were completed in all surgical cases. There was no mention of MRSA status in these forms. Conclusion MRSA remains a risk for sepsis and PICU admissions despite a 100% compliance with screening and decontamination. Adherence to WHO checklist did not result in the administration of correct antibiotics. High risk of postoperative sepsis (6.8%), with 80% needing PICU, irrespective of class of wound, mandates a more robust approach to prevention. Changes need to be made to WHO local surgical checklists.

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Section: Discussionmentioning

confidence: 78%

Experience with Methicillin-Resistant Staphylococcus aureus in a Central London Tertiary Pediatric Hospital

Chahal¹,

Omran²,

Vora

et al. 2022

J Pediatr Infect Dis

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“…Similar results were seen by Jadrajka et al, Ibtesan et al and Vishal et al, who noted Staphylococcus aureus as the predominant pathogen causing SSI in their studies [ 18 , 25 , 26 ]. Also, it has been shown that about 15–30% of the healthy population carry Staphylococcus aureus in their nares which could opportunistically cause SSI [ 27 ]. In addition, fomites, which include bedsheets have also been proven to be the reservoir of Staphylococcus aureus [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of incidence of postoperative wound infection in closed fractures treated by surgical fixation – A prospective study

Radhamony

Raj

Raju

2021

Annals of Medicine and Surgery

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“…The application of nasal mupirocin to decolonize S. aureus and prevent subsequent SSIs is proven effective in many control studies ( 11 , 13 , 20 , 25 , 26 ). Chen AF et al found that the decolonization protocols using intranasal mupirocin and chlorhexidine washes are effective for reducing MRSA/MSSA colonization ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Chen AF et al found that the decolonization protocols using intranasal mupirocin and chlorhexidine washes are effective for reducing MRSA/MSSA colonization ( 13 ). Decolonization of S. aureus using intranasal mupirocin and chlorhexidine in patients undergoing elective orthopedic surgery could significantly increase the risk of postoperative SSI ( 11 , 25 ). Agarwala et al ( 20 ) reported that mupirocin was an effective treatment in clearing MRSA from the nares in adult patients undergoing orthopedic surgery in urban India, thereby reducing the incidence of MRSA SSI.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of preoperative decolonization with nasal povidone iodine in Chinese patients undergoing elective orthopedic surgery: a prospective cross-sectional study

Wang

et al. 2018

Braz J Med Biol Res

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Staphylococcus aureus colonization in the nares of patients undergoing elective orthopedic surgery increases the potential risk of surgical site infections. Methicillin-resistant S. aureus (MRSA) has gained recognition as a pathogen that is no longer only just a hospital-acquired pathogen. Patients positive for MRSA are associated with higher rates of morbidity and mortality following infection. MRSA is commonly found in the nares, and methicillin-sensitive S. aureus (MSSA) is even more prevalent. Recently, studies have determined that screening for this pathogen prior to surgery and diminishing staphylococcal infections at the surgical site will dramatically reduce surgical site infections. A nasal mupirocin treatment is shown to significantly reduce the colonization of the pathogen. However, this treatment is expensive and is currently not available in China. Thus, in this study, we first sought to determine the prevalence of MSSA/MSRA in patients undergoing elective orthopedic surgery in northern China, and then, we treated the positive patients with a nasal povidone-iodine swab. Here, we demonstrate a successful reduction in the colonization of S. aureus. We propose that this treatment could serve as a cost-effective means of eradicating this pathogen in patients undergoing elective orthopedic surgery, which might reduce the rate of surgical site infections.

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Surgical site infection risk following pre-operative MRSA detection in elective orthopaedic surgery

Cited by 7 publications

References 8 publications

Experience with Methicillin-Resistant Staphylococcus aureus in a Central London Tertiary Pediatric Hospital

Experience with Methicillin-Resistant Staphylococcus aureus in a Central London Tertiary Pediatric Hospital

Analysis of incidence of postoperative wound infection in closed fractures treated by surgical fixation – A prospective study

Effectiveness of preoperative decolonization with nasal povidone iodine in Chinese patients undergoing elective orthopedic surgery: a prospective cross-sectional study

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