Clinical Orthopaedics and Related Research®

, Volume 471, Issue 7, pp 2383–2399 | Cite as

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

  • Antonia F. Chen
  • Charles B. Wessel
  • Nalini RaoEmail author



Staphylococcus aureus is the most common organism responsible for orthopaedic surgical site infections (SSIs). Patients who are carriers for methicillin-sensitive S. aureus or methicillin-resistant S. aureus (MRSA) have a higher likelihood of having invasive S. aureus infections. Although some have advocated screening for S. aureus and decolonizing it is unclear whether these efforts reduce SSIs.


The purposes of this study were to determine (1) whether S. aureus screening and decolonization reduce SSIs in orthopaedic patients and (2) if implementing this protocol is cost-effective.


Studies for this systematic review were identified by searching PubMed, which includes MEDLINE (1946–present), (1974–present), and the Cochrane Library’s (John Wiley & Sons) Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTAD), and the NHS Economic Evaluation Database (NHSEED). Comprehensive literature searches were developed using EMTREE, MeSH, and keywords for each of the search concepts of decolonization, MRSA, and orthopedics/orthopedic surgery. Studies published before 1968 were excluded. We analyzed 19 studies examining the ability of the decolonization protocol to reduce SSIs and 10 studies detailing the cost-effectiveness of S. aureus screening and decolonization.


All 19 studies showed a reduction in SSIs or wound complications by instituting a S. aureus screening and decolonization protocol in elective orthopaedic (total joints, spine, and sports) and trauma patients. The S. aureus screening and decolonization protocol also saved costs in orthopaedic patients when comparing the costs of screening and decolonization with the reduction of SSIs.


Preoperative screening and decolonization of S. aureus in orthopaedic patients is a cost-effective means to reduce SSIs.

Level of Evidence

Level IV, systematic review of Level I–IV studies. See the Guidelines for Authors for a complete description of levels of evidence.


Triclosan Mupirocin Orthopaedic Patient Mupirocin Resistance Intranasal Mupirocin 
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 Melissa Ratajeski MLIS, AHIP, RLAT, for assistance with the bibliographic file management software and Carola Van Eck MD, PhD, for language translation.


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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Antonia F. Chen
    • 1
  • Charles B. Wessel
    • 2
  • Nalini Rao
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA
  2. 2.University of Pittsburgh Health Sciences Library SystemUniversity of PittsburghPittsburghUSA
  3. 3.Department of Medicine and Orthopaedic Surgery, Division of Infectious DiseaseUniversity of Pittsburgh School of MedicinePittsburghUSA

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