Clinical Orthopaedics and Related Research®

, Volume 470, Issue 10, pp 2684–2689 | Cite as

What Is the Prevalence of MRSA Colonization in Elective Spine Cases?

  • Antonia F. Chen
  • Srinivas Chivukula
  • Lloydine J. Jacobs
  • Matthew W. Tetreault
  • Joon Y. LeeEmail author
Symposium: 2011 Musculoskeletal Infection Society



The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing. However, the prevalence of MRSA colonization among patients undergoing spine surgery is unclear.


We therefore (1) determined the prevalence of MRSA colonization in a population of patients scheduled for elective spine surgery; and (2) evaluated whether MRSA screening and treatment reduce the rate of early wound complications.


We retrospectively reviewed prospectively collected data from 1002 patients undergoing elective spine surgery in 2010. There were 719 primary and 283 revision surgeries. Instrumentation was used in 72.0% cases and autologous iliac crest bone graft was taken in 65.1%. Twelve patients were lost to followup; of the remaining 990 patients, 503 were screened for MRSA and 487 were not. MRSA-colonized patients were treated with mupirocin and chlorhexidine. An early wound complication was defined as wound drainage or the presence of an abscess. Patients were followed for a minimum of 3 months (average, 7 months; range, 3–545 days).


Of the patients undergoing elective spine surgery and screened for MRSA, 14 of 503 (2.8%) were colonized with MRSA. The rates of early wound complications were similar for patients who were screened and pretreated for MRSA (17 of 503 [3.4%]) compared with those who were not (17 of 487 [3.5%]).


The colonization rate for MRSA in our elective spine surgery population was comparable to that in the arthroplasty literature.

Level of Evidence

Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.


Iliac Crest Bone Graft Intranasal Mupirocin Autologous Iliac Crest Bone Elective Spine Autologous Iliac Crest Bone Graft 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Dr Nalini Rao for her infectious disease expertise and assistance with the MRSA/MSSA screening and decolonization program at our institution.


  1. 1.
    Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total knee arthroplasty. J Bone Joint Surg Br. 2004;86:688–691.PubMedCrossRefGoogle Scholar
  2. 2.
    Committee on Comparative Effectiveness Research Prioritization, Institute of Medicine. Initial National Priorities for Comparative Effectiveness Research. Washington, DC, USA: The National Academies Press; 2009.Google Scholar
  3. 3.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.PubMedCrossRefGoogle Scholar
  4. 4.
    Epstein NE. Preoperative, intraoperative, and postoperative measures to further reduce spinal infections. Surg Neurol Int. 2011;2:17.PubMedCrossRefGoogle Scholar
  5. 5.
    Kalmeijer MD, Coertjens H, van Nieuwland-Bollen PM, Bogaers-Hofman D, de Baere GA, Stuurman A, van Belkum A, Kluytmans JA. Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis. 2002;35:353–358.PubMedCrossRefGoogle Scholar
  6. 6.
    Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG. Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine. 2010;13:158–164.PubMedCrossRefGoogle Scholar
  7. 7.
    Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev. 1997;10:505–520.PubMedGoogle Scholar
  8. 8.
    Lindeque B, Rutigliano J, Williams A, McConnell J. Prevalence of methicillin-resistant Staphylococcus aureus among orthopedic patients at a large academic hospital. Orthopedics. 2008;31:363.PubMedCrossRefGoogle Scholar
  9. 9.
    Nagashima H, Yamane K, Nishi T, Nanjo Y, Teshima R. Recent trends in spinal infections: retrospective analysis of patients treated during the past 50 years. Int Orthop. 2010;34:395–399.PubMedCrossRefGoogle Scholar
  10. 10.
    Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.PubMedCrossRefGoogle Scholar
  11. 11.
    Perl TM, Golub JE. New approaches to reduce Staphylococcus aureus nosocomial infection rates: treating S aureus nasal carriage. Ann Pharmacother. 1998;32:S7.PubMedGoogle Scholar
  12. 12.
    Rao N, Cannella B, Crossett LS, Yates AJ Jr, McGough R 3rd. A preoperative decolonization protocol for Staphylococcus aureus prevents orthopaedic infections. Clin Orthop Relat Res. 2008;466:1343–1348.PubMedCrossRefGoogle Scholar
  13. 13.
    Schuster JM, Rechtine G, Norvell DC, Dettori JR. The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: a systematic review. Spine (Phila Pa 1976). 2010;35(Suppl):S125–S137.Google Scholar
  14. 14.
    Sink EL, Beaulé PE, Sucato D, Kim Y, Millis MB, Dayton M, Trousdale RT, Sierra RJ, Zaltz I, Schoenecker P, Monreal A, Clohisy J. Multicenter study of complications following surgical dislocation of the hip. J Bone Joint Surg Am. 2011;93:1132–1136.PubMedCrossRefGoogle Scholar
  15. 15.
    Slover J, Haas JP, Quirno M, Phillips MS, Bosco JA 3rd. Cost-effectiveness of a Staphylococcus aureus screening and decolonization program for high-risk orthopedic patients. J Arthroplasty. 2011;26:360–365.PubMedCrossRefGoogle Scholar
  16. 16.
    Urban JA. Cost analysis of surgical site infections. Surg Infect (Larchmt). 2006;7(Suppl 1):S19–S22.CrossRefGoogle Scholar
  17. 17.
    Viola RW, King HA, Adler SM, Wilson CB. Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases. Spine (Phila Pa 1976). 1997;22:2444–2450.Google Scholar
  18. 18.
    Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: a review of 2391 consecutive index procedures. J Spinal Disord. 2000;13:422–426.PubMedCrossRefGoogle Scholar
  19. 19.
    Wenzel RP, Perl TM. The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. J Hosp Infect. 1995;31:13.PubMedCrossRefGoogle Scholar
  20. 20.
    Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–1654.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Antonia F. Chen
    • 1
  • Srinivas Chivukula
    • 2
  • Lloydine J. Jacobs
    • 1
  • Matthew W. Tetreault
    • 2
  • Joon Y. Lee
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.University of Pittsburgh Medical SchoolPittsburghUSA

Personalised recommendations