Surgical Site Infections in Orthopaedic Surgery Demonstrate Clones Similar to Those in Orthopaedic Staphylococcus aureus Nasal Carriers

Skråmm, Inge; Moen, Aina Elisabeth Fossum; Årøen, Asbjørn; Bukholm, Geir

doi:10.2106/jbjs.m.00919

Cited by 50 publications

(37 citation statements)

References 39 publications

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“…It was shown as early as the 1950s that S. aureus nasal carriers have an increased risk of developing postoperative wound infections, as compared to noncarriers (Weinstein 1959;Williams et al 1959). This has more recently been verified in patients undergoing orthopedic (Skramm et al 2014) and cardiac surgery (Kluytmans et al 1995). Also S. aureus nasal carriers have a greater risk of developing bacteremia (Wertheim et al 2004a).…”

Section: Infectionmentioning

confidence: 97%

“…It has been shown that persistent nasal carriers have an increased risk of infection as compared to non-carriers (Kluytmans et al 1995;Wertheim et al 2004a;Skramm et al 2014) and that >80 % of the infections are caused by the carrier strain, as a result of endogenous transmission (von Eiff et al 2001;Wertheim et al 2004a). Eradication of nasal carriage has proven effective in the reduction of endogenous infections (Talon et al 1995;Kluytmans et al 1996a;Kluytmans et al 1996b).…”

Section: Transmission Routes and Sources (Papers III And Iv)mentioning

confidence: 99%

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Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

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Staphylococcus aureus is a commensal of the human flora, primarily colonizing the anterior nares and throat, but it may also cause infections ranging from mild skin and soft tissue infections to severe diseases such as endocarditis and septicemia. S. aureus is also a major nosocomial problem increasing with the worldwide dissemination of methicillin-resistant S. aureus (MRSA).The main vector for bacterial cross-transmission in healthcare settings is the hands of healthcare workers (HCWs). No S. aureus was detected in the air in this thesis demonstrating that transmission through air is not important. Despite the fact that good compliance with hand hygiene is essential to prevent cross-transmission the compliance is generally less than 50 %.Gold standard to track bacterial transmission in healthcare settings has for long been pulsedfield gel electrophoresis (PFGE), a method that is labor-intensive, lacks consensus protocol and relies on semi-subjective analysis. Molecular typing by sequencing of the hypervariable part of the S. aureus protein A gene (spa typing) has overcome these problems and has shown promising results in epidemiological investigations.The aims of this thesis were to study bacterial transmission with S. aureus colonization of newborn infants as a model and to evaluate spa typing as a molecular tool. Additionally, the influence of compliance with hygiene guidelines on S. aureus transmission was assessed.Analysis of 280 MRSA isolates by spa typing revealed excellent typeability and epidemiological concordance and satisfactory discriminatory power. Additionally, spa typing was considered superior to PFGE thanks to its accessibility, ease of use and rapidity. Also, spa typing results are registered in a global database, facilitating inter-laboratory comparison.The prevalence of S. aureus ranged from 41 % to 66 % in the populations studied and males had the highest colonization rate. Throat was the premier colonization site for adults and transmission from individuals colonized in the throat only was documented, suggesting that throat cultures should be included in S. aureus screening programs. The umbilicus was the premier colonization site for newborn infants. Incubating the swabs in enrichment broth prior to plating increased the prevalence of S. aureus positive samples by 46 %, resulting in prevalence viii ranging from 51 % to 70 % in the populations studied. Thus enrichment prior to plating is necessary to determine more truthful S. aureus colonization rates. There were no indications of an institutional flora, as the colonization rates, spa type distribution and antibiotic resistance prevalence were similar among parents and HCWs.Direct observations and self-reporting by HCWs were both validated as tools for monitoring compliance with hygiene guidelines. The compliance with hygiene guidelines was significantly higher following a 10-point hygiene intervention as compared to baseline. The compliance was also higher three years after the intervention in three of four participating departm...

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Section: Infectionmentioning

confidence: 97%

Section: Transmission Routes and Sources (Papers III And Iv)mentioning

confidence: 99%

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

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“…The ecologic niche of S aureus is the nasal passages [30], and the association between nasal carriage of S aureus and surgical site infection (SSI) was established in 1959 [33]. Carriers of S aureus are two to nine times more likely to develop an SSI, and it has been shown that 85% of SSIs can be traced to endogenous colonization of the patients [6,18,25,31,34]. In 1999, the Centers for Disease Control and Prevention (CDC) recognized nasal colonization of S aureus as a risk factor for SSI [20].…”

Section: Introductionmentioning

confidence: 99%

Twenty Percent of Patients May Remain Colonized With Methicillin-resistant Staphylococcus aureus Despite a Decolonization Protocol in Patients Undergoing Elective Total Joint Arthroplasty

Baratz

Hallmark

Odum

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Staphylococcus aureus is the most commonly isolated organism in periprosthetic joint infection (PJI). Resistant strains such as methicillin-resistant S aureus (MRSA) are on the rise, and many programs have instituted decolonization protocols. There are limited data on the success of S aureus nasal decolonization programs and their impact on PJI. Questions/purposes The purposes of this study were to (1) determine the proportion of patients successfully decolonized using a 2-week protocol; (2) compare infection risks between our surveillance and decolonization protocol group against a historical control cohort to evaluate changes in proportions of S aureus infections; and (3) assess infection risk based on carrier type, comparing S aureus carriers with noncarrier controls. Methods We retrospectively evaluated a group of 3434 patients who underwent elective primary and revision hip and knee arthroplasty over a 2-year period; each patient in the treatment group underwent a surveillance protocol, and a therapeutic regimen of mupurocin and chlorhexidine was instituted when colonization criteria were met. A 2009 to 2010 comparative historical cohort was chosen as the control group. We compared risks of infection between our treatment group and the historical control cohort. Furthermore, in patients who developed surgical site infections (SSIs), we compared the proportions of each S aureus type between the two cohorts. Finally, we compared infection rates based on carrier status. Surveillance for infection was carried out by the hospital infection control coordinator using the Centers for Disease Control and Prevention (CDC) criteria. During the time period of this study, the CDC defined hospital-acquired infection related to a surgical procedure as any infection diagnosed within 1 year of the procedure. With the numbers available, we had 41% power to detect a difference of 0.3% in infection rate between the treatment and control groups. To achieve 80% power, a total of 72,033 patients would be needed.

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“…Identifying carriers early is vital for patients undergoing surgery, as MRSA is a leading cause of surgical-site infection (SSI) (22, 24). Patients undergoing cardiothoracic and neurological surgery are at an elevated risk of developing SSIs due to endogenous and hematogenous pathogen access to the thoracic and cranial cavities, with SSIs from MRSA strongly correlating with postoperative morbidity and mortality (22, 24–26). In spite of these risks, cardiothoracic and neurological surgery patients appear to be at a low risk for contracting MRSA.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Prevalence of Staphylococcus aureus in Cardiothoracic and Neurological Surgical Patients

Kapoor

Barnett

Gutmann

et al. 2014

Front. Public Health

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Methicillin-resistant Staphylococcus aureus (MRSA) is a global cause of both hospital and community-acquired infection. This retrospective, observational study determined the prevalence of MRSA carriers in cardiothoracic and neurological surgical patients presenting to an outpatient preoperative assessment center in Columbus, OH. Aggressive skin and soft-tissue infection may be caused by MRSA with potentially fatal complications. Cardiothoracic and neurological surgical patients are at high risk for surgical-site infection. Results indicated that 4.25% of the sample carried MRSA and 25.25% carried methicillin-sensitive S. aureus.

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Surgical Site Infections in Orthopaedic Surgery Demonstrate Clones Similar to Those in Orthopaedic Staphylococcus aureus Nasal Carriers

Abstract: Surgical site infections might be more frequently caused by endogenous transmission than was previously assumed. Perioperative preventive efforts must focus more on this route to further decrease the risk of postoperative orthopaedic infections.

Cited by 50 publications

References 39 publications

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Twenty Percent of Patients May Remain Colonized With Methicillin-resistant Staphylococcus aureus Despite a Decolonization Protocol in Patients Undergoing Elective Total Joint Arthroplasty

Preoperative Prevalence of Staphylococcus aureus in Cardiothoracic and Neurological Surgical Patients

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