Risk Factors for Staphylococcus aureus Nasal Colonization in Joint Arthroplasty Patients

Walsh, Amanda L.; Fields, Adam C.; Dieterich, James D.; Chen, Darwin D.; Bronson, Michael J.; Moucha, Calin S.

doi:10.1016/j.arth.2017.12.038

Cited by 33 publications

(25 citation statements)

References 22 publications

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“…Immunosuppression medication use was a risk factor for colonization for both MRSA and MSSA in the univariate analysis. After multivariate analysis, this only held true for MRSA which echoed the findings of Walsh et al 15 This finding can infer that immunosuppression due to medication use can make patients more susceptible to colonization due to the inherent mechanism of the medication use in lowering the patients' immune response. Conversely, patients on immunosuppression medication could be inferred to carry a larger comorbidity burden which would increase the risk for colonization.…”

Section: Discussionsupporting

confidence: 58%

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: Discussionsupporting

confidence: 58%

Predictors of Staphylococcus Aureus Nasal Colonization in Joint Arthroplasty Patients

et al. 2020

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“…In addition, acquiring nasal microorganisms is far less invasive than bronchoscopy. Furthermore, nasal bacteria, that is, the bacterial communities in the uppermost part of the nasal passage, can contribute to infection transmission in humans, and accumulating evidence suggests that a close relationship exists between the nasal flora and infection [17,18]. Overall, we propose that examining the nasal microbiota can benefit studies investigating airway microbiomes during sepsis.…”

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confidence: 93%

Septic Patients in the Intensive Care Unit Present Different Nasal Microbiotas

et al. 2019

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Aim: The primary objective of this study was to evaluate correlations among mortality, intensive care unit (ICU) length of stay and airway microbiotas in septic patients. Materials & methods: A deep-sequencing analysis of the 16S rRNA gene V4 region was performed. Results: The nasal microbiota in septic patients was dominated by three nasal bacterial types ( Corynebacterium , Staphylococcus and Acinetobacter ). The Acinetobacter type was associated with the lowest diversity and longest length of stay (median: 9 days), and the Corynebacterium type was associated with the shortest length of stay. We found that the Acinetobacter type in the >9-day group was associated with the highest mortality (33%). Conclusion: Septic patients have three nasal microbiota types, and the nasal microbiota is related to the length of stay and mortality.

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“…[27] In the USA, several studies of patients for TJA report the incidence of S aureus colonization to range between 17.5%-25.1% for MSSA and 1.8%-5% for MRSA respectively. [28][29][30] Several risk factors have been described for S aureus colonization including gender, age, recent hospitalization, ethnicity, genetic predisposition, diabetes mellitus, HIV, haemodialysis, other concurrent skin infections and antibiotic treatment misuse. [34] This study did not identify any 8 statistically significant risk factors that predicted for the pre-operative colonization with S aureus, which was likely due to the small sample size.…”

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 are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty. Staphylococcus aureus colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in Staphylococcus 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 Staphylococcus aureus colonization in patients awaiting Total Joint Arthroplasty 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 Staphylococcus 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 Staphylococcus aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant Staphylococcus aureus . Nasal swabs returned a yield of 81.6%(n=31), with groin swabs and axillary swabs at 39.5% (n=15) and28.9% (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 Staphylococcus aureuscolonized 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 Staphylococcus aureus colonization in patients undergoing elective TotalJoint Arthroplasty 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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Risk Factors for Staphylococcus aureus Nasal Colonization in Joint Arthroplasty Patients

Cited by 33 publications

References 22 publications

Predictors of Staphylococcus Aureus Nasal Colonization in Joint Arthroplasty Patients

Predictors of Staphylococcus Aureus Nasal Colonization in Joint Arthroplasty Patients

Septic Patients in the Intensive Care Unit Present Different Nasal Microbiotas

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

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