Prophylaxis with nasal decolonization in patients submitted to total knee and hip arthroplasty: systematic review and meta-analysis

Abstract

Despite the evolution of the total knee and hip arthroplasty surgery, high postoperative complication rates in the short and long term still persist. Infection is one of the most challenging complications; due to its gravity and treatment difficulties, prophylaxis protocols have been created to decrease its incidence. The objective of this study was to evaluate the impact of the prophylaxis protocol for methicillin-resistant Staphylococcus aureus decolonization of the nares in patients previously identified by swab cultures, who were to be submitted to a total joint arthroplasty. A systematic review with meta-analysis was conducted, following the PRISMA-2015 protocol, using the descriptors: “arthroplasty” and “nasal decolonization,” or “joint arthroplasty” and “decolonization,” or “joint arthroplasty” and “nasal decolonization,” for final selection of four observational studies from 79 references identified. This study included a total sample of 10,179 patients, divided in two groups: the control group (4788 patients) and intervention group (5391 patients). It was observed that the intervention group, in which prophylaxis with nasal decolonization was used, 59 (1.09%) of the patients developed a surgical site infection, while in the control group there were 86 cases of surgical site infection (1.79%). This trend repeated itself in all articles, showing no publication biases, forming a homogeneous sample. The use of a prophylaxis protocol for decolonization of methicillin-resistant Staphylococcus aureus, reduced surgical site infection cases by approximately 39%.

Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis

“…To the best of our knowledge, this is the most comprehensive meta-analysis examining the association of S. aureus screening and decolonization with SSI after TKA and THA. We are aware of previous meta-analyses on this topic [30,45,46]. Studies performed by Levy et al [45] and Chen et al [46] contained other orthopedic surgeries, which would lead to a mass of confounding factors.…”

“…After two authors reviewed the titles and abstracts, 73 irrelevant citations were removed. The remaining 46 fulltext papers were then retrieved for a more detailed analysis, of which 37 papers were excluded for several reasons, such as irrelevant research (n = 18), lacking raw date (n = 4) [18][19][20][21], containing revision or other [20][21][22][23][24][25][26][27][28][29][30][31][32][33], and inaccessible language (n = 2) [34,35]. Finally, a total of nine studies were included in this research [4,[10][11][12][13][36][37][38][39].…”

Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

“…The anterior nares are the primary site of S aureus colonization whilst other areas that may serve as reservoirs include the oropharynx, axillae, groin, perineum, forehead, and neck. [12,37] Sampling these sites in addition to the anterior nares may improve the detection rates of S aureus however this will infer an increased financial burden.…”

“…[27] Sporer et al (2016) reported that decolonization of S aureus carriers revealed a 69% reduction in the rate of SSIs in comparison with a control group who had not been screened and treated. [28] In a systematic review of 79 papers from both the Portuguese and English literature, Sadigursky et al (2017) reported that the use of prophylaxis to promote pre-operative decolonization of MRSA decreased the incidence of SSI by almost 39%. [37] Jeans et al (2018) showed that the adoption a S aureus screening and decolonization programme in patients awaiting TJA reduced the PJI rate significantly from 1.92-1.41%.…”

Treatment of Periprosthetic Infection with Silver-Doped Implants Based on Two-Dimensionally Ordered Linear Chain Carbon

“…Значимым фактором риска развития инфекции в области хирургического вмешательства является Staphylococcus aureus в носоглотке [8,9,10,11]. Профилактика ППИ путем деколонизации метициллин-резистентных штаммов Staphylococcus aureus может уменьшить количество случаев заражения в месте хирургического вмешательства примерно на 39% [12].…”