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

Abstract

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.

Identifying Common Pathogens in Periprosthetic Joint Infection and Testing Drug‐resistance Rate for Different Antibiotics: A Prospective, Single Center Study in Beijing

“…Even so, we believe that our study could provide some information on current treatment of PJI. Previous studies have found that decolonization plays an essential role in postoperative infection, and the use of prophylactic antibiotics against the decolonization might decrease the rate of PJI. Further study should focus on finding common decolonizing bacterium in patients undertaking elective orthopaedic surgery in China, and further test the appropriateness of using cefuroxime and clindamycin in prophylaxis in primary TJA.…”

Systematic review of a patient care bundle in reducing staphylococcal infections in cardiac and orthopaedic surgery

“…All studies contributed to the meta-analysis. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Nine of the eligible studies 19,22,24,25,[27][28][29][30]35 included cardiac patients and nine 20,21,23,26,[31][32][33]36,37 included orthopaedic patients; the remaining studies included both types of patients. Two cardiac studies were on paediatric populations 19,25 and the remaining were all adults.…”

“…Mupirocin (2% ointment) was used under different regimens by 18 studies, 19,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] and povidone-iodine was used in two studies as the nasal decolonization agent. 21,33 Chlorhexidine was used for skin decolonization in patients in the form of soaps for showering 19,20,[26][27][28][29]34,35,37 or wipes for skin cleansing. 21 Mouthwash using chlorhexidine was applied to patients in one study.…”

Total knee arthroplasty and infection: how surgeons can reduce the risks

“…27 However, literature still exists doubting the effectiveness of this treatment in prevention. 28-31 …”