Methicillin-resistant Staphylococcus aureus colonization in patients undergoing primary total hip arthroplasty

Abstract

Introduction. Nasal and skin colonization by methicillin-resistant Staphylococcus aureus (MRSA) are linked to a higher incidence of infection after total joint replacement. The prevalence of colonization is poorly defined in Latin American countries. Aim. The aim of the present study was to determine the prevalence of MRSA colonization in the nostrils and groin using real-time polymerase chain reaction (RT-PCR) in patients undergoing total hip arthroplasty (THA). Methodology. In this cross-sectional study, 146 patients undergoing THA between December 2015 and March 2017 in a tertiary-care university-affiliated hospital in Chile were screened for MRSA colonization before the procedure using RT-PCR independently in the nostrils and groin. Risk factors for colonization were documented. Results. Seven of the 146 (5 %) patients undergoing THA were carriers of MRSA in the nostrils and/or the groin. Recent antibiotic use was identified as a risk factor for colonization, OR=4.86 [95 % confidence interval (CI): 1.56–13.96]. Patients reporting at least one of the seven surveyed risk factors had an OR of 2.39 (95 % CI: 0.37–25.77) for colonization. MRSA colonization frequency was twofold higher in the groin as opposed to the nostrils (P=0.014). Conclusion. Five percent of the patients undergoing THA were identified as carriers of MRSA. Recent antibiotic use is a relevant risk factor for MRSA colonization in patients undergoing primary total hip arthroplasty.

Prevalencia de portación nasal de Staphylococcus aureus sensible y resistente a la meticilina en candidatos a artroplastia total de cadera o rodilla

“…Cultures have a reported sensitivity ranging from 66% to 90%, whereas RT-PCRhave 99% to 100% of sensitivity. 25,43,44 This fact may explain the lower prevalence rate of MRSA (0.41%) compared to that of other studies using molecular biology methods and multiple sampling sites, such as the one by Schweitzer et al, 29 who found a rate of 5%.…”

“…Of the final sample of 454 subjects, 103 (22.7%) were positive for MSSA, and 1 (0.2%) was positive for MRSA, 28 which is consistent with our findings. Recently, Schweitzer et al 29 published a series of 146 THA patients with nasal and inguinal samples collected on the day of surgery for a molecular study with reverse transcription-polymerase chain reaction (RT-PCR). A total of 7 (5%) cases were positive for MRSA, and the previous use of antibiotics was a risk factor.…”

“…Una debilidad de nuestro estudio, considerando la disponibilidad de recursos limitados en nuestro hospital, fue que se utilizaron cultivos para la búsqueda de los microorganismos, los cuales tienen una sensibilidad reportada entre 66% y90%, a diferencia del 99% al 100% con uso de RT-PCR. 25 43 44 Esto pudiese explicar la menor tasa de prevalencia de SARM (0,41%) en comparación a otros estudios en los que se utilizaron métodos de biología molecular y múltiples zonas de toma de muestra, como el de Schweitzer et al 29 (5%).…”

“…De los 454 incluidos finalmente, 103 (22,7%) fueron positivos para SASM, y 1 (0,2%), para SARM, lo que es similar a nuestros hallazgos. Recientemente, Schweitzer et al 29 publicaron una serie de 146 pacientes sometidos a ATC, en la que se tomaron muestras nasales e inguinales el día de la cirugía, y se realizó estudio molecular con reacción en cadena de la polimerasa con transcripción inversa ( reverse-transcription polymerase chain reaction , RT-PCR, en inglés). Entre sus resultados, encontraron 7 (5%) casos positivos para SARM, e identificaron el uso previo de antibióticos como factor de riesgo.…”

Diagnóstico e prevenção de infecções articulares periprotéticas por Staphylococcus aureus após fratura de quadril: Revisão sistemática de literatura

“…They also highlighted that individuals with recent use of antibiotics are more likely to have MRSA colonization. 17 In a study carried out in a single center in Taiwan, the main pathogens associated with PJI in the hip were identified. Of the total of 159 registered cases, 27% were caused by S. aureus, 14% by CoNS, 21% by MRSA, and 4.1% by fungi and mycobacteria.…”