Empiric treatment is less costly than Staphylococcus aureus screening and decolonization in total joint arthroplasty patients

Stirton, Jacob; Herron, Joseph Scott; Nandi, Sumon

doi:10.1016/j.artd.2017.11.011

Cited by 6 publications

(8 citation statements)

References 11 publications

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“…This methodology has been shown to be the most cost-effective approach in reducing SSIs as compared with the standard screening and treatment strategies. [23][24][25][26] Additionally, this method helps reduce confusion for false negative or positive results as well as streamlines the presurgical process. Courville et al found that both treat-all and screen and treat strategies in TKA and THA were cost effective compared with no treatment and the cost-effectiveness ratios between the treat all and screen and treat strategies were similar with trivial cost differences.…”

Section: Discussionmentioning

confidence: 99%

“…21 22 Multiple protocols for addressing and treating nasal carriage of S. aureus have been evaluated with various financial implications and recommendations. 23 24 25 26 27…”

Section: Discussionmentioning

confidence: 99%

“…21,22 Multiple protocols for addressing and treating nasal carriage of S. aureus have been evaluated with various financial implications and recommendations. [23][24][25][26][27] An emerging and popular protocol in the literature is implementation of a treat all methodology. In this protocol, the screening process for colonization of S. aureus is removed and all patients undergoing surgery are treated with topical mupirocin.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Staphylococcus Aureus Nasal Colonization in Joint Arthroplasty Patients

et al. 2020

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Early identification and treatment of Staphylococcus aureus (S. aureus) nasal colonization can reduce the risk of prosthetic joint infection. The purpose of this study was to evaluate patient-specific predictors for S. aureus nasal colonization in total joint arthroplasty patients to aid in preoperative screening protocols. A total of 2,147 arthroplasty patients who were preoperatively screened for S. aureus nasal colonization were retrospectively reviewed. Factors analyzed consisted of procedure type, primary diagnosis, gender, ethnicity, body mass index, the presence of chronic obstructive pulmonary disease, obstructive sleep apnea, hypertension, diabetes mellitus, use of immunosuppression medication, smoking history, and chronic kidney disease. Univariate and multivariate analyses were performed with significance p < 0.05 and 95% confidence intervals. Overall, 3.7% (79) of our cohort tested positive for methicillin-resistant Staphylococcus aureus (MRSA), and 23.2% (493) tested positive for methicillin-sensitive Staphylococcus aureus (MSSA). Independent predictors for MRSA colonization were of Hispanic ethnicity (p = 0.001, odds ratio [OR] 13.98, confidence interval [CI] 2.97–65.76), immunosuppression medication use (p = 0.006, OR 2.82, CI 1.35–5.87), and revision total hip arthroplasty (THA) procedure (p < 0.001, OR 7.51, CI 2.58–21.89). Independent predictors for MSSA colonization were body mass index (BMI) >35 (p = 0.002, OR 1.57, CI 1.19–2.1). Variables were found to be protective against MSSA colonization including female gender (p = 0.012, OR 0.76, CI 0.61–0.94), age 60 to 69 (p = 0.025, OR 0.75, CI 0.58–0.96), and age 70 to 79 (p = 0.002, OR 0.63, CI 0.47–0.84). Age, Hispanic ethnicity, gender, revision THA, use of immunosuppression medication, and elevated BMI were independent risk factors for S. aureus nasal colonization.

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Section: Discussionmentioning

confidence: 99%

“…21 22 Multiple protocols for addressing and treating nasal carriage of S. aureus have been evaluated with various financial implications and recommendations. 23 24 25 26 27…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of Staphylococcus Aureus Nasal Colonization in Joint Arthroplasty Patients

et al. 2020

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“…In this study, mupirocin ointment at 1928.3 yen/product is needed to implement UD for all patients when including personnel costs. In the United States, Stirton et al reported the cost of empiric treatment with mupirocin for all patients as an estimated $24.65 per patient (equivalent to 2711.5 yen at 110 yen to 1 US Dollar), which included the personnel costs for instruction on mupirocin application [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

What is the most cost‐effective strategy for nasal screening and Staphylococcus aureus decolonization in patients undergoing total hip arthroplasty?

Tonotsuka

Sugiyama

Amagami

et al. 2021

BMC Musculoskelet Disord

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Background To reduce periprosthetic joint infection after total hip arthroplasty (THA), several nasal screening and decolonization strategies for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) have been performed. These include universal decolonization (UD; i.e., no screening and decolonization for all patients), universal screening and target decolonization (US; i.e., screening for all patients and decolonization for bacterial positive patients), and target screening and decolonization (TS; i.e., screening and decolonization for high-risk populations only). Although TS is the most cost-effective strategy, useful risk factors must be identified. The purpose of this study was to evaluate the presence of predictive factors that enable the TS strategy to be successfully implemented and to compare the costs of each strategy. Methods A total of 1654 patients scheduled for primary or revision THA (1464 female, 190 male; mean age 64 years) were screened prior to surgery for bacterial colonization of the nasal mucosa. Risk factors for positive MRSA and S. aureus (including both MRSA and MSSA) tests were analyzed according to the following parameters: sex, age ≥ 80 years, body mass index ≥ 30 kg/m2, antibiotic use within 3 years, corticosteroid use, serum albumin < 3.5 g/dL, glomerular filtration rate < 50 mL/min, presence of brain, thyroid, cardiac, or pulmonary disease, diabetes, asthma, smoking status, and whether revision surgery was performed. The average cost of each strategy was calculated. Results In total, 29 patients (1.8 %) tested positive for MRSA and 445 (26.9 %) tested positive for S. aureus. No parameters were identified as independent risk factors for MRSA and only female sex was identified as a risk factor for S. aureus (p = 0.003; odds ratio: 1.790; 95 % confidence interval: 1.210–2.640). The average cost of each strategy was 1928.3 yen for UD, 717.6 yen for US, and 717.6 yen for TS (for eradicating MRSA), and 1928.3 yen for UD, 1201.6 yen for US, and 1160.4 yen for TS (for eradicating S. aureus). Conclusions No useful predictive parameters for implementing the TS strategy were identified. Based on cost implications, US is the most cost-effective strategy for THA patients.

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“…In this study, mupirocin ointment at 1641.3 yen/product is needed to implement UD for all patients and this excludes personnel costs. In the United States, Stirton et al reported the cost of empiric treatment with mupirocin for all patients as an estimated $24.65 per patient (equivalent to 2711.5 yen at 110 yen to 1 US Dollar), which included the personnel costs for instruction on mupirocin application [19].…”

Section: Discussionmentioning

confidence: 99%

Which is the most appropriate strategy for nasal screening and Staphylococcus aureus decolonization in total hip arthroplasty patients?

Tonotsuka¹,

Sugiyama²,

Amagami³

et al. 2020

Preprint

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Background: To reduce periprosthetic joint infection after total hip arthroplasty (THA), several nasal screening and decolonization strategies for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) have been performed. These include universal decolonization (UD; i.e., no screening and decolonization for all patients), universal screening and target decolonization (US; i.e., screening for all patients and decolonization for bacterial positive patients), and target screening and decolonization (TS; i.e., screening and decolonization for high-risk populations only). Although TS is the most cost-effective strategy, useful risk factors must be identified. The purpose of this study was to evaluate the presence of predictive factors that enable the TS strategy to be successfully implemented and to compare the costs of each strategy.Methods: A total of 1654 patients scheduled for primary or revision THA (1464 women, 190 men; mean age 64 years) were screened prior to surgery for bacterial colonization of the nasal mucosa. Risk factors for positive MRSA and MRSA/MSSA tests were analyzed according to the following parameters: sex, age ≥80 years, body mass index ≥30 kg/m2, antibiotic use within 3 years, corticosteroid use, serum albumin <3.5 g/dL, glomerular filtration rate <50 mL/min, presence of brain, thyroid, cardiac or pulmonary disease, diabetes, asthma, and smoking habit. The average cost of each strategy was calculated.Results: In total, 29 patients (1.8%) tested positive for MRSA and 445 (26.9%) tested positive for MRSA/MSSA. No parameters were identified as independent risk factors for MRSA and only female sex was identified as a risk factor for MRSA/MSSA (p=0.003; odds ratio: 1.790; 95% confidence interval: 1.210-2.640). The average cost of each strategy for eradicating MRSA was 1641.3 yen for UD, 285.8 yen for US, and 252.3 yen for TS.Conclusions: No useful predictive parameters for implementing the TS strategy were identified. Based on cost implications, US is the most cost-effective strategy for THA patients.

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Empiric treatment is less costly than Staphylococcus aureus screening and decolonization in total joint arthroplasty patients

Cited by 6 publications

References 11 publications

Predictors of Staphylococcus Aureus Nasal Colonization in Joint Arthroplasty Patients

Predictors of Staphylococcus Aureus Nasal Colonization in Joint Arthroplasty Patients

What is the most cost‐effective strategy for nasal screening and Staphylococcus aureus decolonization in patients undergoing total hip arthroplasty?

Which is the most appropriate strategy for nasal screening and Staphylococcus aureus decolonization in total hip arthroplasty patients?

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