Screening for nasal carriage of Staphylococcus aureus among patients scheduled to undergo orthopedic surgery: Incidence of surgical site infection by nasal carriage

Chahal

Pacing Clinical Electrophis

et al. 2017

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

International survey of knowledge, attitudes, and practices of cardiologists regarding prevention and management of cardiac implantable electronic device infections

Chahal

Pacing Clinical Electrophis

et al. 2017

“…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].…”

Section: Study Selectionmentioning

confidence: 99%

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

et al. 2020

Background Nasal Staphylococcus aureus (S. aureus) screening and decolonization has been widely used to reduce surgical site infections (SSIs) prior to total knee and hip arthroplasty (TKA and THA). However, it remains considerably controversial. The aim of this study was to ascertain whether this scheme could reduce SSIs and periprosthetic joint infections (PJIs) following elective primary total joint arthroplasty (TJA). Methods A systematic search was performed in MEDLINE, Embase, and the Cochrane Library until October, 2019. Outcomes of interest included SSI, PJI, superficial infection, and different bacterial species that caused infections. Data from eligible studies were then extracted and synthesized. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated. We also performed additional analyses to evaluate whether there were differences in postoperative SSIs caused by S. aureus or other bacteria. Results Nine studies were included in our meta-analysis. The pooled data elucidated that nasal S. aureus screening and decolonization dramatically mitigated the risk of SSI, PJI, and superficial infection compared to nondecolonization group. The analysis of bacterial species causing infection also showed that the S. aureus infections postoperative were significantly decreased in the decolonization group. However, there was no statistical difference in the SSI caused by other bacteria between the two groups. Conclusion S. aureus screening and decolonization prior to elective primary THA and TKA could significantly decrease the risk of SSI and PJI. However, more robust studies are needed to further evaluate the impact of S. aureus screening and decolonization on infection risk after TJA.

“…3 Increasing methicillin resistance has decreased the efficacy of intravenous cephalosporins as the standard preoperative antibiotic prophylaxis used in orthopedic procedures in general, and spine surgery in particular. [3][4][5] Studies have reported that more than 60% of wound infection isolates in the United States are cephalosporin-resistant, including MRSA and coagulase-negative Staphylococcus. 6,7 Among orthopedic patients in the United States, 20% to 30% have anterior nares colonized by methicillin-sensitive S aureus (MSSA), and 2% to 6% are colonized by MRSA.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy

Kerbel

Kirchner

Sunkerneni

et al. 2019

Global Spine Journal

Study Design: Break-even cost analysis. Objective: The goal of this study is to examine the cost-effectiveness of vancomycin powder for preventing infection following lumbar laminectomy. Methods: The product cost of vancomycin powder was obtained from our institution’s purchasing records. Infection rates and revision costs for lumbar laminectomy and lumbar laminectomy with fusion were obtained from the literature. A break-even analysis was then performed to determine the absolute risk reduction (ARR) in infection rate to make prophylactic application of vancomycin powder cost-effective. Analysis of lumbar laminectomy with fusion was performed for comparison. Results: Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in lumbar laminectomy if the infection rate of 4.2% decreased by an ARR of 0.015%. Laminectomy with fusion was also determined to be cost-effective at the same cost of vancomycin powder if the infection rate of 8.5% decreased by an ARR of 0.0034%. The current highest cost reported in the literature, $44.00 per gram of vancomycin powder, remained cost-effective with ARRs of 0.21% and 0.048% for laminectomy and laminectomy with fusion, respectively. Varying the baseline infection rate did not influence the ARR for either procedure when the analysis was performed using the product cost of vancomycin at our institution. Conclusions: This break-even analysis demonstrates that prophylactic vancomycin powder can be highly cost-effective for lumbar laminectomy. At our institution, vancomycin powder is economically justified if it prevents at least one infection out of 6700 lumbar laminectomy surgeries.