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Clinical Efficacy of Nasal Screening and Methicillin-Resistant Staphylococcus aureus Decolonization in Total Hip Arthroplasty without Chlorhexidine Soap or Vancomycin

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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a known risk factor for periprosthetic joint infection (PJI). In our facility, preoperative prophylaxis with mupirocin without the chlorhexidine soap scrub or vancomycin was consistently implemented for more than 15 years. This study aimed to evaluate the current screening and treatment of intranasal MRSA colonization in our elective primary THA patient population.

Methods

All patients who underwent primary THA between April 2011, and March 2021 were included in this analysis. All patients were screened preoperatively for nasal MRSA approximately 1 month before surgery. Patients with nasal MRSA contamination are treated with topical mupirocin to eradicate the bacteria before surgery. The patients were examined again approximately two weeks before surgery. We evaluated the current screening and treatment of intranasal colonization with MRSA in our elective primary total hip arthroplasty (THA) patient population.

Results

Out of 6251 patients, 106 (1.7%) had nasal MRSA contamination. The bacteria were not eradicated in three (3.6%) patients at the second screening. Twenty-two joints (0.35%) out of the 6251 had deep infections. Only 1 patient out of the 106 MRSA nasal carriers suffered from PJI. Twenty-one of the 6145 non-carriers had PJI. The difference between the prevalence of nasal MRSA contamination and the incidence of deep infections was not statistically significant.

Conclusion

Our findings suggest that screening of all patients for nasal MRSA before THA followed by mupirocin calcium treatment if needed is sufficient PJI prophylaxis.

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Authors and Affiliations

  1. Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan

    Masahiko Mihara, Kazuo Hirakawa, Satoshi Takayanagi, Daigo Kobayashi & Akira Morita

  2. Shin-Yurigaoka General Hospital, 255 Hurusawa-Tuko Asaoku, Kawasaki, Kanagawa, 215-0026, Japan

    Yushi Miyamae

Authors
  1. Masahiko Mihara
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  2. Kazuo Hirakawa
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  3. Satoshi Takayanagi
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  4. Daigo Kobayashi
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  5. Akira Morita
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  6. Yushi Miyamae
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Correspondence to Masahiko Mihara.

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Conflict of interest

All authors have no conflicts of interest directly relevant to the content of this article. Dr. Mihara, Dr. Hirakawa and Dr. Takayanagi report personal fees from Zimmer Biomet, outside the submitted work. Dr. Kobayashi, Dr. Morita and Dr. Miyamae have nothing to disclose.

Ethical standards

This retrospective study was approved by our local institutional review board.

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Written informed consent was obtained from all patients in retrospective studies in our institution.

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Mihara, M., Hirakawa, K., Takayanagi, S. et al. Clinical Efficacy of Nasal Screening and Methicillin-Resistant Staphylococcus aureus Decolonization in Total Hip Arthroplasty without Chlorhexidine Soap or Vancomycin. JOIO 58, 412–416 (2024). https://doi.org/10.1007/s43465-024-01109-3

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  • DOI: https://doi.org/10.1007/s43465-024-01109-3

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