Clinical Orthopaedics and Related Research

, 466:1349

Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection

  • Donna M. Hacek
  • William J. Robb
  • Suzanne M. Paule
  • James C. Kudrna
  • Van Paul Stamos
  • Lance R. Peterson
Symposium: Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society

DOI: 10.1007/s11999-008-0210-y

Cite this article as:
Hacek, D.M., Robb, W.J., Paule, S.M. et al. Clin Orthop Relat Res (2008) 466: 1349. doi:10.1007/s11999-008-0210-y

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.

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Donna M. Hacek
    • 1
    • 2
  • William J. Robb
    • 3
    • 4
  • Suzanne M. Paule
    • 1
  • James C. Kudrna
    • 3
    • 4
  • Van Paul Stamos
    • 3
    • 4
  • Lance R. Peterson
    • 1
    • 4
  1. 1.Evanston Northwestern HealthcareEvanstonUSA
  2. 2.Clinical Microbiology Division, Department of Pathology and Laboratory MedicineEvanston HospitalEvanstonUSA
  3. 3.Illinois Bone and Joint InstituteGlenbrookUSA
  4. 4.Northwestern University’s Feinberg School of MedicineChicagoUSA