Resultados de una intervención de descolonización de Staphylococcus aureus en pacientes portadores a los que se indica una prótesis articular

Allende, J.M. Barbero; Cabrera, Juan Romanyk; Ruiz, Eduardo Montero; Purroy, Alfonso Vallés; Molero, Virginia Melgar; López, Rosa Agudo; García, Luis Gete; Álvarez, Joaquín López

doi:10.1016/j.eimc.2014.03.004

Cited by 18 publications

(12 citation statements)

References 27 publications

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“…The effectiveness of mupirocin in the decolonization of S. aureus nasal carriage was demonstrated in a meta-analysis which found a success rate of up to 90% after one week of follow-up, which decreased to 60% after at least two weeks 39 . Even higher rates (98%) of decolonization have been achieved, when using mupirocin together with chlorhexidine soap in a joint elective and urgent arthroplasty population 40 . Moreover, in our protocol decolonization was carried out only in the 5 days before surgery, minimizing possibilities of recolonization.…”

Section: Discussionmentioning

confidence: 99%

Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty

Pelfort

Alba

Brugués

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to evaluate whether the establishment of a preoperative screening and decolonization protocol for Staphylococcus aureus carriers undergoing total knee arthroplasty (TKA) could decrease the incidence of periprosthetic joint infection (PJI) caused by this microorganism.MethodsWe conducted a retrospective study comparing a control group comprising 400 patients (134 men, and 266 women; mean age: 72.2 ± 6.8 years) who went through surgery between January 2009 and December 2013, with a second intervention group of 403 patients (125 men, and 278 women; mean age: 72.4 ± 6.9 years) in which the protocol of screening and decolonization of S. aureus nasal carriers was applied between January 2014 and December 2016. During this latter period patients were preoperatively screened and, if positive, treated with mupirocin nasal ointment and chlorhexidine soap, for 5 days prior to surgery.ResultsIn the control group, 17 of 400 patients (4.2%) had a SSI, 8 (2%) of them caused by S. aureus and 9 (2.2%) by other microorganisms. In the intervention group 20.6% of patients had a positive S. aureus nasal swab and were treated according to the protocol. 5 of 403 patients (1.2%) in this group had a SSI, 1 (0.2%) due to S. aureus and 4 (1%) to other microorganisms. When comparing surgical-site infection (SSI) rates between the two groups, we found a statistically significant reduction in both global SSI (p = 0.009) and specifically S. aureus SSI (p = 0.02), in the intervention group. No decolonized S. aureus nasal carrier presented a SSI.DiscussionIn patients undergoing TKA a preoperative screening and decolonization protocol for S. aureus nasal carriers, using mupirocin nasal ointment and chlorhexidine soap, is an effective measure to reduce the rate of SSI caused by this microorganism.Level of EvidenceLevel III; Therapeutic Study.

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Section: Discussionmentioning

confidence: 99%

Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty

Pelfort

Alba

Brugués

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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“…[39] Barbero Allende et al (2015) showed that the identical strategy to the one employed in our study resulted in a 98% decolonization rate. [34] The use of intranasal mupirocin and full body chlorhexidine wash yielded good results and supports the combination of both treatment modalities.…”

Section: Discussionmentioning

confidence: 72%

“…[39] Similarly, Barbero Allende et al (2015) showed that the identical decolonization strategy to the one employed in our study resulted in an amelioration of the rate of SSI by 40.7%. [34] There were several major weaknesses identified in evaluation of the study. The primary limitation was the small sample size of the population.…”

Section: Discussionmentioning

confidence: 99%

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

Pietrzak

Maharaj

Mokete

2020

Preprint

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Background: Periprosthetic joint infections (PJIs) are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty (TJA). Staphylococcus aureus (S aureus) colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in S aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of S aureus colonization in patients awaiting TJA in South Africa. Methods: We prospectively assessed 119 patients awaiting Total Knee Arthroplasty and Total Hip Arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for S aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t-tests, Fisher’s exact tests, and chi square analyses. Results: The overall prevalence of Methicillin Sensitive S aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant S aureus. Nasal swabs returned a yield of 81.6% (n=31), with groin swabs and axillary swabs at 39.5% (n=15) and 28.9% (n=11) respectively. Eradication was successful in 94.74% (n=36) after five days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n=9). The 30-day readmission rate in the S aureus -colonized group was 7.9% (n=3) as opposed to 7.4% (n=6) in the non-colonized cohort. There were no 60- and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years. Conclusions: The rate of S aureus colonization in patients undergoing elective TJA in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.

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“…Em todos os casos, foram utilizados no protocolo de descolonização mupirocina tópica (pomada) nas narinas com aplicação de 2 a 3 vezes ao dia durante 5 dias, associado a banhos diários com clorexidina a 2-4%. 21,[25][26][27][28][29][30][31][32][33] Destes, apenas três ressaltaram a efetividade da descolonização para redução de IAP, sendo que em um dos estudos houve redução apenas da IAP precoce causada por S. aureus, não reduzindo a IAP global. 27 Nos outros dois estudos, houve redução da IAP global 32,33 e ainda um dos estudos mostrou redução de infecções do sítio cirúrgico nos pacientes com descolonização pré-operatória.…”

Section: Discussão Biomarcadores E Diagnóstico De Iapunclassified

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

Oliveira,

Costa,

Gama

et al. 2024

Rev Bras Ortop (Sao Paulo)

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ResumoAs artroplastias de quadril são procedimentos cirúrgicos largamente realizados em todo o mundo buscando retorno da funcionalidade, alívio da dor e melhora da qualidade de vida dos pacientes acometidos por quadros de osteoartrite, fraturas de colo de fêmur e osteonecrose da cabeça femoral, dentre outras etiologias. As infecções articulares periprotéticas são uma das complicações mais temidas pela elevada morbimortalidade associada, com elevado número de patógenos que podem estar associados à sua etiologia. O objetivo do presente estudo foi analisar aspectos correlacionados à ocorrência da infecção, diagnóstico e prevenção de infecções articulares periprotéticas no quadril associadas a Staphylococcus aureus após cirurgia corretiva de fraturas de quadril. Trata-se de uma revisão sistemática de literatura realizada nas bases de dados indexadas na Medical Literature Analysis and Retrieval System Online (MEDLINE, na sigla em inglês) realizada de acordo com os preceitos estabelecidos pela metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, na sigla em inglês). Foram selecionados para análise 20 estudos que abordavam o diagnóstico e prevenção de infecções articulares periprotéticas após fraturas de quadril. Observa-se que não há consenso na literatura sobre medidas preventivas para ocorrência de tais processo infecciosos. Dentre os fatores de risco para ocorrência e gravidade das infecções por S. aureus após artroplastias de quadril foram citados obesidade, maior tempo cirúrgico, maior idade, quadros de imunossupressão, uso recente de antibióticos e multicomorbidades. O uso de biomarcadores para diagnóstico precoce, bem como processos de triagem, descolonização e antibioticoprofilaxia estão entre os procedimentos preventivos propostos na literatura.

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Resultados de una intervención de descolonización de Staphylococcus aureus en pacientes portadores a los que se indica una prótesis articular

Cited by 18 publications

References 27 publications

Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty

Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty

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

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

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