The role of MRSA screening in joint-replacement surgery

Abstract

The aim of this prospective study was to determine the effect of screening for methicillin-resistant Staphylococcus aureus (MRSA), in patients undergoing total hip and knee replacements, on reducing hospital-acquired infections and the length of hospital stay. We included 395 patients admitted to the elective orthopaedic ward for hip and knee replacements (knee 210; hip 185) from 16 October 2000 to 15 October 2001. Group 1 included 164 admissions before 16 April 2001 when MRSA swabs were not compulsory. Group 2 included 231 admissions after 16 April 2001 when axillary, nasal and groin swabs had to be negative for MRSA. Four patients in group 1 had post-operative MRSA infection compared with none in group 2. The mean length of hospital stay decreased significantly from 10.43 days +/- SD 4.2 days in group 1 to 9.47 days +/- SD 2.6 days in group 2. There was a significant reduction in the incidence of hospital-acquired infections following the introduction of pre-admission screening.

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

“…The reduction of overall SSIs ranged from 13% to 200% ( Fig. 2A) [9,11,16,20,24,26,30,43,47], the reduction of S. aureus SSIs ranged from 40% to 200% (Fig. 2B) [5,9,16,19,42,51], the reduction of MRSA SSIs ranged from 29% to 149% (Fig.…”

“…aureus detection was performed by PCR in four studies [5,19,30,40], culture in 13 studies [7,9,11,16,20,24,26,29,36,42,43,49,57], mixed methods of detection in one aggregate study [51], and unknown in one study [47]. Fifteen of the studies reported SSI reductions when only S. aureuspositive screened patients were decolonized, and eight studies [9,11,16,20,26,36,51,57] reported decreases in Table 2.…”

“…SSIs when all patients were decolonized. Regarding the method of decolonization, six studies exclusively used mupirocin [9,11,16,24,26,51], 10 used mupirocin and chlorhexidine [5,7,19,20,29,30,40,42,43,49], and three used mupirocin and triclosan [36,47,57] ( Table 2). The range of SSI reduction varied among groups; studies that used mupirocin showed only 29% to 57% reductions in total SSIs; studies that used mupirocin and chlorhexidine showed 13% to 81% reductions in total SSIs, 56% to 200% reductions in S. aureus SSIs, and 29% to 100% reductions in MRSA SSIs; and studies that used mupirocin and triclosan showed a 200% reduction in total SSIs and 56% to 149% reductions in MRSA SSIs.…”

“…Of the 19 studies that evaluated the ability of S. aureus screening and decolonization to reduce SSI in orthopaedic patients, there were nine prospective studies [5,26,30,42,43,47,49,51,57] and 10 retrospective studies [7,9,11,16,19,20,24,29,36,40] (Table 1). Most studies evaluating S. aureus screening and decolonization in orthopaedic patients were conducted on patients undergoing elective total joint arthroplasty [11,16,19,20,25,30,42,43,47,49], although many studies did evaluate all elective orthopaedic patients [5,9,24,29,36,40,51,57], spine patients [7,30], and trauma patients [36].…”

“…Most studies evaluating S. aureus screening and decolonization in orthopaedic patients were conducted on patients undergoing elective total joint arthroplasty [11,16,19,20,25,30,42,43,47,49], although many studies did evaluate all elective orthopaedic patients [5,9,24,29,36,40,51,57], spine patients [7,30], and trauma patients [36]. The majority of studies detected S. aureus colonization using cultures, most SSIs were defined by CDC criteria, the majority of studies did not differentiate between superficial versus deep infections, and most of the patients who underwent decolonization were positive for S. aureus on nasal screens ( Table 2).…”