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Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection

  • Symposium: Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Surgical site infections (SSIs) with Staphylococcus aureus are a recognized adverse event of hip and knee replacements. We evaluated the impact of a program to detect S. aureus nasal carriers before surgery with preoperative decolonization (using mupirocin twice daily for 5 days prior to surgery) of carriers. Nasal swab samples were obtained from patients prior to surgery from 8/1/2003 through 2/28/2005. Samples were tested using real-time PCR technology to detect S. aureus. The group that developed S. aureus SSI was compared to a combined concurrent and historical control for one year following the operation. S. aureus caused 71% of SSIs in the combined control groups. Of the 1495 surgical candidates evaluated, 912 (61.0%) were screened for S. aureus; 223 of those screened (24.5%) were positive and then decolonized with mupirocin. Among the 223 positive and decolonized patients, three (1.3%) developed a SSI. Among the 689 screen-negative patients, four (0.6%) developed SSIs for an overall rate of 0.77%. Among the 583 control patients who were not screened or decolonized, 10 (1.7%) developed S. aureus SSIs. SSIs from other organisms were 0.44% and 0.69%, respectively.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Evanston Northwestern Healthcare, Evanston, IL, USA

    Donna M. Hacek MT (ASCP), Suzanne M. Paule BS & Lance R. Peterson MD

  2. Clinical Microbiology Division, Department of Pathology and Laboratory Medicine, Evanston Hospital, 2650 Ridge Avenue, Rm. 1936 D&T, Evanston, IL, 60201, USA

    Donna M. Hacek MT (ASCP)

  3. Illinois Bone and Joint Institute, Glenbrook, IL, USA

    William J. Robb MD, James C. Kudrna MD & Van Paul Stamos MD

  4. Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA

    William J. Robb MD, James C. Kudrna MD, Van Paul Stamos MD & Lance R. Peterson MD

Authors
  1. Donna M. Hacek MT (ASCP)
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  2. William J. Robb MD
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  3. Suzanne M. Paule BS
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  4. James C. Kudrna MD
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  5. Van Paul Stamos MD
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  6. Lance R. Peterson MD
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Corresponding author

Correspondence to Donna M. Hacek MT (ASCP).

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Hacek, D.M., Robb, W.J., Paule, S.M. et al. Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection. Clin Orthop Relat Res 466, 1349–1355 (2008). https://doi.org/10.1007/s11999-008-0210-y

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  • DOI: https://doi.org/10.1007/s11999-008-0210-y

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