Screening for and decolonization of Staphylococcus aureus carriers before total joint replacement is associated with lower S aureus prosthetic joint infection rates (original) (raw)
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Annals of surgery, 2015
To identify patients who benefit most from Staphylococcus aureus screening and decolonization treatment upon admission. S. aureus carriers are at increased risk of developing surgical-site infections with S. aureus. Previously, we demonstrated in a randomized, placebo-controlled trial (RCT) that these infections can largely be prevented by detection of carriage and decolonization treatment upon admission. In this study, we analyzed 1- and 3-year mortality rates in both treatment arms of the RCT to identify patient groups that should be targeted when implementing the screen-and-treat strategy. Three years after enrolment in the RCT, mortality dates of all surgical patients were checked. One- and 3-year mortality rates were calculated for all patients and for various subgroups. After 3 years, 44 of 431 (10.2%) and 43 of 362 (11.9%) patients had died in the mupirocin/chlorhexidine and placebo groups, respectively. No significant differences in mortality rates were observed between the ...
Acta Orthopaedica et Traumatologica Turcica, 2019
The 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. Methods: We 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. Results: In 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 ¼ 0.009) and specifically S. aureus SSI (p ¼ 0.02), in the intervention group. No decolonized S. aureus nasal carrier presented a SSI. Discussion: In 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.
Infection Control and Hospital Epidemiology, 2014
We surveyed the Society for Healthcare Epidemiology of America Research Network, the Minnesota Association for Professionals in Infection Control and Epidemiology, and the Minnesota Hospital Association to assess presurgical Staphylococcus aureus screening and decolonization practices. The practices varied widely among responding facilities. The majority of respondents (63%) did not screen for S. aureus preoperatively.
Decolonization of orthopedic surgical team S. aureus carriers: impact on surgical-site infections
Journal of Orthopaedics and Traumatology, 2010
Background Orthopedic surgical-site infection (SSI), mostly due to S. aureus, is recognized as a major adverse event. This research aims to verify the usefulness of surgical team decolonization in order to reduce the risk of surgical-site infection. Materials and methods We performed swabs of both nares and oropharynx to identify S. aureus carriers among orthopedic team members who consented to cooperate with the study. Carriers were treated with local application of mupirocin ointment. Results Retrospective study of 1,000 consecutive patients operated before surgical team decolonization showed 6% SSIs. Of the 300 cases considered after decolonization, none developed SSI. Conclusions Though we are aware that more data need to be collected, this work might be relevant for the introduction of a new preventive protocol.
The Journal of arthroplasty, 2018
This article presents a break-even analysis for preoperative Staphylococcus aureus colonization screening and decolonization protocols in total hip arthroplasty (THA) and total knee arthroplasty (TKA). Protocol costs, baseline infection rates after arthroplasty, and average revision costs were obtained from institutional records and the literature. The break-even analysis determined the absolute risk reduction (ARR) in infection rate required for cost-effectiveness. S aureus nasal screening ($144.07) was cost effective when initial infection rates of TKA (1.10%) and THA (1.63%) had an ARR of 0.56% and 0.45%, respectively. The most inexpensive decolonization treatment ($5.09) was cost effective with an ARR of 0.02% for both TKA and THA. The most expensive decolonization option ($37.67) was cost effective with ARRs of 0.15% (TKA) and 0.12% (THA). Preoperative S aureus decolonization can be highly cost effective, whereas colonization screening requires excessively high reductions in in...
Infectious Diseases and Therapy
Introduction: Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of Staphylococcus aureus PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome. Methods: A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used Jesú s Rodríguez-Baño and Maria Dolores del Toro contributed equally as senior authors of the study. Members of The ARTHR-IS Group are listed in Acknowledgements section.
Open Forum Infectious Diseases, 2020
Background Staphylococcus aureus is the leading cause of prosthetic joint infection (PJI). Beyond the antibiogram, little attention has been paid to the influence of deep microbiological characteristics on patient prognosis. Our aim was to investigate whether microbiological genotypic and phenotypic features have a significant influence on infection pathogenesis and patient outcome. Methods A prospective multicenter study was performed, including all S. aureus PJIs (2016–2017). Clinical data and phenotypic (agr functionality, β-hemolysis, biofilm formation) and genotypic characteristics of the strains were collected. Biofilm susceptibility to antimicrobials was investigated (minimal biofilm eradication concentration [MBEC] assay). Results Eighty-eight patients (39.8% men, age 74.7 ± 14.1 years) were included. Forty-five had early postoperative infections (EPIs), 21 had chronic infections (CPIs), and 19 had hematogenous infections (HIs). Twenty (22.7%) were caused by methicillin-resi...
The Journal of Arthroplasty, 2013
Staphylcoccus decolonization prior to surgery is used to prevent surgical site infections (SSIs) after total joint arthroplasty (TJA). To determine if current treatment protocols result in successful decolonization of methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA), 106 consecutive patients were screened for nasal MSSA/MRSA colonization pre-operatively and on the day of surgery. Colonized patients used intranasal mupirocin twice a day and chlorhexidine showers daily 5 days prior to surgery. Preoperatively, 24 joints (22.0%) were positive for MSSA colonization and 5 joints (4.6%) were positive for MRSA colonization. On the day of surgery, 3 joints (2.8%) who underwent decolonization were positive for MSSA colonization and 0 joints were positive for MRSA colonization. The reduction in MSSA colonization was significant (P b 0.001), while the eradication of MRSA colonization approached statistical significance (P = 0.063). Current decolonization protocols using intranasal mupirocin and chlorhexidine washes are effective for reducing MRSA/MSSA colonization.
Journal of Clinical Practice and Research, 2023
Objective: Prosthetic joint infections (PJIs) can lead to extended hospital stays, necessitate additional surgeries, and require antimicrobial treatment, thereby increasing costs and causing significant morbidity. This study aims to ascertain surgeon-specific infection rates and identify risk factors associated with PJIs. Materials and Methods: This research was conducted with two study arms between January 1, 2017, and February 28, 2019. In the first arm, all cases undergoing primary total knee and hip arthroplasty by the same surgeon were prospectively included and monitored for the development of PJIs. In the second arm, all patients admitted to the same surgeon due to PJI were included. Results: The first arm comprised 152 patients, of whom five developed PJIs (3.2%). Risk factors for PJI development included diabetes mellitus (p=0.030), rheumatoid arthritis (p=0.014), superficial surgical wound infections in the same joint (p=0.001), and postoperative hematomas (p=0.008). In the second arm, 23 patients with PJIs were included. Gram-positive microorganisms (84.6%) were the most frequently isolated pathogens. The overall treatment success rate stood at 76%, with a treatment success rate of 72.2% for patients receiving daptomycin. Conclusion: Effective measures such as perioperative glycemic control, regulation of immunosuppressive drugs, management of anticoagulant therapy, postoperative wound care by trained personnel, adherence to infection control protocols, and tailoring of PJI treatments based on local surveillance data are crucial for preventing PJIs and achieving treatment success.