Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty (original) (raw)
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Health care associated infections have imposed a huge burden on present medical management. One of the commonest causes for surgical site infection is nasal carriage of Staphylococcus aureus. Decolonization of this organism from nasal and extra nasal sites may reduce the risk of Health care associated infections. A prospective study was conducted, in which all patients undergoing general surgery from January 2017 to December 2017were included. Preoperatively all patients were screened for nasal carriage of S.aureus by conventional culture method, cefoxitin disc and to detect (Methicillin-Resistant Staphylococcus aureus) MRSA and kit agglutination method to detect Mec A gene of MRSA. The (Surgical Site Infection) SSI was recorded based on the criteria of (Centers for Disease Control and Prevention) CDC guidelines. Screening was performed in 456 cases of these 122 (26.7%) cases had positive nasal swab for S.aureus. Among the positive screened patients 102 (83.6%) were identified as (Methicillin-sensitive Staphylococcus aureus) MSSA carriers and 20 (16.4%) cases were MRSA carriers. All the positive screened patients were treated with intranasal mupirocin application and chlorhexidine bath for 5 days. On postoperative follow up 8 (6.5%) cases developed SSI with S.aureus among carriers and 6 (1.8%) cases developed SSI with S.aureus among non carriers. In conclusion nasal carriers carry increased increase of development of S.aureus SSI compared to non carriers. These patients may benefit by proper preoperative treatment to eradicate nasal and extra nasal carriage.
Staphylococcus aureus Nasal Colonization in Preoperative Orthopaedic Outpatients
Clinical Orthopaedics and Related Research, 2008
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.
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.
1998
Surgical site infections (SSI) due to Staphylococcus aureus among 256 male and 158 female patients (mean age, 28 years) undergoing elective surgery at the Soba University Hospital (Khartoum, Sudan) were studied. During an 11-month study period all patients were analyzed for nasal carriage of S. aureus at the time of admission. Follow-up of the development of SSI proceeded until 4 weeks after the operations. In addition, nasal swabs were obtained periodically during the same period from 82 members of the staff. In order to discriminate autoinfection from cross infection, bacterial isolates were typed by random amplification of polymorphic DNA (RAPD), pulsed-field gel electrophoresis (PFGE) of DNA macrorestriction fragments, and restriction fragment length polymorphism analysis of the protein A and coagulase genes. Preoperative cultures revealed the presence of S. aureus in the noses of 98 patients (24%). The overall number of postsurgical wound infections in the entire group was 57 (14%), 24 of which were due to S. aureus. Only 6 of the 98 nasal S. aureus carriers suffered from wound infections by the same species. In these six cases the infecting strain could not be genetically discriminated from the nasal inhabitant, substantiating autoinfection. However, nasal carriage of S. aureus is not a significant risk factor for the development of SSI in this setting (6 of 98 patients with autoinfection versus 18 of 316 patients [414 ؊ 98 patients] with cross infection; P ؍ 0.81), most probably due to the fact that noncarriers are at a significant and relatively large risk for acquiring an independent S. aureus SSI. The other S. aureus strains causing SSI showed a high degree of genetic heterogeneity, demonstrating that it is not an epidemic strain that is causing the SSI. Among the staff personnel screened, 47.4% did not carry S. aureus in the nose at any time during the study period, whereas 13.2% persistently carried a single strain in the nose. Another 39.5% could be classified as intermittent carriers. When strains derived from staff personnel were genetically typed, it was demonstrated that most of the strains represented genetic variants clearly differing from the isolates causing SSI. On the other hand, possible cross colonization among staff personnel and even cross infection from staff personnel to patients or from patient to patient were demonstrated in some cases, but epidemic spread of a single strain or a few clonally related strains of S. aureus could be excluded.
American Journal of Infection Control, 2019
Background: Prosthetic joint infections (PJI) can be devastating postoperative complications after total joint replacement (TJR). The role of decolonization of Staphylococcus aureus carriers prior to surgery still remains unclear, and the most recent guidelines do not state a formal recommendation for such strategy. Our purpose was to seek further evidence supporting preoperative screening and S aureus decolonization in patients undergoing TJR. Methods: This was a quasiexperimental quality improvement study comparing a 5-year baseline of deep and organ-space PJIs (2005-2010) to a 1-year intervention period (May 2015 to July 2016). The intervention consisted of nasal and throat screening for S aureus preoperatively and decolonization of carriers over 5 days prior to surgery. Results: Prior to the intervention, we identified 42 deep and/or organ-space PJIs in 8,505 patients undergoing TJR (0.5%). S aureus was the causal microorganism in 28 of 42 (66.6%) cases. During the intervention, 22.5% (424 of 1,883) of patients were S aureus carriers. The PJI rate was similar overall (0.4%, 7 of 1,883; odds ratio, 0.75; 95% confidence interval, 0.34-1.67; P = .58), but there was a significant reduction in S aureus PJI to only 1 case during the intervention (odds ratio, 0.15; 95% confidence interval, 0.004-0.94; P = .039). Conclusions: Active screening for S aureus and decolonization of carriers prior to TJR was associated with a reduction in PJI due to S aureus, but no changes in overall PJI rates were observed.