Staphylococcus aureus Colonization among Arthroplasty Patients Previously Treated by a Decolonization Protocol: A Pilot Study

Economedes, Demetri M; Deirmengian, Gregory K.; Deirmengian, Carl

doi:10.1007/s11999-013-2856-3

Cited by 21 publications

(12 citation statements)

References 23 publications

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“…It should be noted that we did not test how long animals stayed clear of S. aureus following mupirocin treatment, though we did observe that all 6 animals generally stayed clear of S. aureus at all sites for at least 4 weeks. Decolonization of humans with mupirocin nasal ointment is considered beneficial for preventing postoperative infection (27,44), but S. aureus carriage is recurrent in many subjects (45). More studies that investigate the impact of mupirocin treatment on microbial community dynamics as well as new agents to be used for S. aureus decolonization are needed, and the pig-tailed macaque might be useful in this regard.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Pig-Tailed Macaque (Macaca nemestrina) as a Model of Human Staphylococcus aureus Nasal Carriage

et al. 2018

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nasal carriage is a common condition affecting both healthy and immunocompromised populations and provides a reservoir for dissemination of potentially infectious strains by casual contact. The factors regulating the onset and duration of nasal colonization are mostly unknown, and a human-relevant animal model is needed. Here, we screened 17 pig-tailed macaques () for carriage, and 14 of 17 animals tested positive in the nose at one or both screening sessions (8 weeks apart), while the other 3 animals were negative in the nose but positive in the pharynx at least once. As in humans, colonization was densest in the nose, and treatment of the nostrils with mupirocin ointment effectively cleared the nostrils and 6 extranasal body sites. Experimental nasal colonization was established with 10 CFU/nostril, and both autologous and nonautologous strains survived over 40 days without any apparent adverse effects. A human nasal isolate (strain D579, sequence type 398) was carried in 4 of 6 animals for over 3 weeks. Nostrils that did eradicate experimentally applied exhibited neutrophilic innate immunity marked by elevated nasal interleukin-1β (IL-1β), IL-8, and monocyte chemotactic protein 1 levels and a 10-fold decreased IL-1 receptor antagonist/IL-1β ratio within 7 days postinoculation, analogous to the human condition. Taken together, pig-tailed macaques represent a physiological model of human nasal carriage that may be utilized for testing natural colonization and decolonization mechanisms as well as novel classes of anti- therapeutics.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Pig-Tailed Macaque (Macaca nemestrina) as a Model of Human Staphylococcus aureus Nasal Carriage

et al. 2018

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“…Empirical use of mupirocin ointment without screening is shown to be a simple, safe, cost-effective [11] and associated with a decreased incidence of SSI [12, 13]. On the other hand, there are concerns regarding the development of resistance to mupirocin in the setting of routine use [14]. …”

Section: Before the Day Of Surgerymentioning

confidence: 99%

The Prevention of Periprosthetic Joint Infections

Küçükdurmaz

Parvızı

2016

TOORTHJ

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Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.

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“…59 According to a prospective study, 33% of preoperatively decolonized patients were recolonized with S. aureus 15 months after TJA. 60 However, there is no evidence that colonization with S. aureus after TJA is a risk factor for late PJI, and therefore no treatment is advised for S. aureus carriers after TJA (►Table 1).…”

Section: Staphylococcus Aureus Screening and Decolonizationmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection: What Are the Effective Strategies?

2014

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Periprosthetic joint infection (PJI) following total knee arthroplasty is a major burden for patients and health systems. Prevention of this challenging complication through implementation of effective strategies should be a priority. These strategies should encompass various levels of patient care. Multiple modifiable risk factors such as uncontrolled hyperglycemia, obesity, smoking, substance abuse, and nasal colonization with Staphylococcus aureus have been described for PJI. Preoperative recognition and mitigation of these risk factors along with optimization of nonmodifiable risk factors such as kidney, liver, or immune system insufficiency can considerably decrease the risk of PJI. A comprehensive perioperative protocol should involve optimization of the operative environment to reduce the number of bacteria and particulates in the air. Several surgical and nonsurgical details of intraoperative care such as maintenance of normothermia, skin preparation, surgical field irrigation, wound closure, and duration of surgical and anesthetic procedure can influence the occurrence of PJI. Prophylactic perioperative antibiotic administration is probably one of the most important strategies in preventing PJI. Implementation of surgical safety checklist can diminish the risk of perioperative complications, particularly surgical site infection. Controversy regarding efficacy, efficiency, and optimization of some preventive measures continues to exist due to inconsistency or inadequacy of available evidence. Novel research has focused on designing PJI-resistant implants and developing vaccines that target molecule components with major role in the process of bacterial adhesion to the implant or periprosthetic tissues.

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Staphylococcus aureus Colonization among Arthroplasty Patients Previously Treated by a Decolonization Protocol: A Pilot Study

Cited by 21 publications

References 23 publications

Evaluation of the Pig-Tailed Macaque (Macaca nemestrina) as a Model of Human Staphylococcus aureus Nasal Carriage

Evaluation of the Pig-Tailed Macaque (Macaca nemestrina) as a Model of Human Staphylococcus aureus Nasal Carriage

The Prevention of Periprosthetic Joint Infections

Prevention of Periprosthetic Joint Infection: What Are the Effective Strategies?

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