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Staphylococcus aureus Nasal Colonization in Preoperative Orthopaedic Outpatients

  • Original Article
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Clinical Orthopaedics and Related Research

Abstract

Nasal colonization with Staphylococcus aureus (SA) increases the risk of surgical site infection (SSI). We first (1) determined the prevalence of asymptomatic nasal colonization with SA, (2) assessed trends in methicillin resistance with time, (3) ascertained risk factors for nasal colonization; and (4) correlated SSI to nasal colonization status and procedure. We performed a cross-sectional analysis of SA nasal colonization among healthy preoperative orthopaedic outpatients between 2003–2005 who were within 2 weeks of surgery. Of 284 patients, 86 (30%) carried SA; of these, 81 (94%) were colonized with methicillin-sensitive and five (6%) with methicillin-resistant SA (MRSA). Total SA colonization increased from 25/78 (32%) in 2003 to 37/97 (38%) in 2005, and colonization with MRSA increased from 0/78 (0%) to four of 97 (4%), respectively. We found no associations between nasal carriage and demographics or procedures. Surgical site infection occurred in nine of 282 (3%), four of which were attributable to SA; these included 0/43 (0%) carriers who received decolonization with 2% mupirocin, two of 43 (4.7%) who declined decolonization, and two of 196 (1.0%) who were noncarriers. Nasal colonization with SA, including MRSA, among preoperative orthopaedic outpatients is increasing and their rates reflect community rates. Knowledge of colonization status may be important in decolonization, choosing perioperative or any subsequent empiric antibiotics.

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Acknowledgments

We thank the Denver Health Orthopedic Clinic nursing staff for assistance in performing anterior nares swabs; our microbiology laboratory staff for processing the large volume of surveillance cultures; and Marybeth Delassandro, BS M(ASCP), for critical review of the manuscript.

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Authors and Affiliations

  1. Department of Medicine (Division of Infectious Diseases), Denver Health Medical Center, University of Colorado School of Medicine, 660 Bannock MC-4000, Denver, CO, 80204, USA

    Connie Savor Price MD

  2. Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA

    Allison Williams ND, PhD, Giby Philips MD, Michael Dayton MD, Wade Smith MD & Steven Morgan MD

Authors
  1. Connie Savor Price MD
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  2. Allison Williams ND, PhD
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  3. Giby Philips MD
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  4. Michael Dayton MD
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  5. Wade Smith MD
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  6. Steven Morgan MD
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Corresponding author

Correspondence to Connie Savor Price MD.

Additional information

One of the authors (CSP) has received funding from GlaxoSmithKline Pharmaceuticals.

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Price, C.S., Williams, A., Philips, G. et al. Staphylococcus aureus Nasal Colonization in Preoperative Orthopaedic Outpatients. Clin Orthop Relat Res 466, 2842–2847 (2008). https://doi.org/10.1007/s11999-008-0337-x

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  • DOI: https://doi.org/10.1007/s11999-008-0337-x

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