Preoperative Screening/Decolonization for Staphylococcus aureus to Prevent Orthopedic Surgical Site Infection

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

“…The reduction of overall SSIs ranged from 13% to 200% ( Fig. 2A) [9,11,16,20,24,26,30,43,47], the reduction of S. aureus SSIs ranged from 40% to 200% (Fig. 2B) [5,9,16,19,42,51], the reduction of MRSA SSIs ranged from 29% to 149% (Fig.…”

“…Although all studies that were included showed reductions in SSIs with use of a decolonization protocol, not all reductions were statistically significant [20,26,29,36,49]. When evaluating the location of different SSIs, four studies showed that there was no statistically significant difference between the intervention group and the nonintervention group regarding deep or superficial SSIs [26,42,43,49]. However, one study [5] that decolonized only screen positive patients showed that the rate of deep SSIs decreased with use of a S. aureus decolonization protocol, and another study [29] that also decolonized only screen positive patients showed there was a significant decrease in deep SSIs with decolonization and moderate decrease in organ space or joint SSIs.…”

“…Of the 19 studies that evaluated the ability of S. aureus screening and decolonization to reduce SSI in orthopaedic patients, there were nine prospective studies [5,26,30,42,43,47,49,51,57] and 10 retrospective studies [7,9,11,16,19,20,24,29,36,40] (Table 1). Most studies evaluating S. aureus screening and decolonization in orthopaedic patients were conducted on patients undergoing elective total joint arthroplasty [11,16,19,20,25,30,42,43,47,49], although many studies did evaluate all elective orthopaedic patients [5,9,24,29,36,40,51,57], spine patients [7,30], and trauma patients [36].…”

“…Most studies evaluating S. aureus screening and decolonization in orthopaedic patients were conducted on patients undergoing elective total joint arthroplasty [11,16,19,20,25,30,42,43,47,49], although many studies did evaluate all elective orthopaedic patients [5,9,24,29,36,40,51,57], spine patients [7,30], and trauma patients [36]. The majority of studies detected S. aureus colonization using cultures, most SSIs were defined by CDC criteria, the majority of studies did not differentiate between superficial versus deep infections, and most of the patients who underwent decolonization were positive for S. aureus on nasal screens ( Table 2).…”

“…Ten studies (Table 3) examined the cost of implementing a S. aureus screening and decolonization protocol [10,19,22,34,36,42,43,48,52,55]. The method of evaluating costs differed among studies, because four of the studies were based on economic models [10,34,48,55], whereas ITT = intention to treat; MSSA = methicillin-sensitive S. aureus; MRSA = methicillin-resistant S. aureus; RCT = randomized controlled trial; RR = relative risk; SSI = surgical site infection.…”