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Is nasal carriage of Staphylococcus aureus the main acquisition pathway for surgical-site infection in orthopaedic surgery?

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Abstract

The endogenous or exogenous origin of Staphylococcus aureus, responsible for orthopaedic surgical-site infections (SSI), remains debated. We conducted a multicentre prospective cohort study to analyse the respective part of exogenous contamination and endogenous self-inoculation by S. aureus during elective orthopaedic surgery. The nose of each consecutive patient was sampled before surgery. Strains of S. aureus isolated from the nose and the wound, in the case of SSI, were compared by antibiotypes or pulsed-field gel electrophoresis (PFGE). A total of 3,908 consecutive patients undergoing orthopaedic surgery were included. Seventy-seven patients developed an SSI (2%), including 22 related to S. aureus (0.6%). S. aureus was isolated from the nose of 790 patients (20.2%) at the time of surgery. In the multivariate analysis, S. aureus nasal carriage was found to be a risk factor for S. aureus SSI in orthopaedic surgery. However, only nine subjects exhibiting S. aureus SSI had been found to be carriers before surgery: when compared, three pairs of strains were considered to be different and six similar. In most cases of S. aureus SSI, either an endogenous origin could not be demonstrated or pre-operative nasal colonisation retrieved a strain that was different from the one recovered from the surgical site

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Acknowledgements

The authors particularly thank Nicolas Eydoux, Estelle Badel and Fabrice Di Palma for the collection and recording of the data.

Conflict of interest statement

The authors have received funding support from the Ministère de la Santé, France, Programme Hospitalier de Recherche Clinique (PHRC Dépistaph) for this study. No conflict of interest is declared. No financial interest in a pharmaceutical company is declared.

Author information

Authors and Affiliations

  1. University Hospital and University Jean Monnet, Saint Etienne, France

    P. Berthelot, F. Grattard, C. Cazorla, F. Farizon, B. Pozzetto & F. Lucht

  2. Group “Mucosal Immunity and Pathogen Agents”, University Jean Monnet, Saint Etienne, France

    P. Berthelot, F. Grattard, C. Cazorla, B. Pozzetto & F. Lucht

  3. Clinique Mutualiste, Saint Etienne, France

    J.-P. Passot, J.-P. Fayard & R. Meley

  4. University Hospital, Lyon, France

    J. Bejuy

  5. Department of Infectious Diseases and Infection Control Unit, CHU Saint Etienne, 42055, Saint Etienne Cedex 02, France

    P. Berthelot

Authors
  1. P. Berthelot
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  2. F. Grattard
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  3. C. Cazorla
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  4. J.-P. Passot
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  5. J.-P. Fayard
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  6. R. Meley
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  7. J. Bejuy
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  8. F. Farizon
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  9. B. Pozzetto
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  10. F. Lucht
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Corresponding author

Correspondence to P. Berthelot.

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Contributors

PB, CC and FL participated in the design of the study, in the collection, analysis and interpretation of the clinical data, in the writing of the report and the decision to submit the paper for publication. FG and BP participated in the collection analysis, interpretation of the microbiological data and the writing of the report. JPP, JPF, JB, MHF and FF participated in various aspects of trial conduct and patient referral. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and the accuracy of the data analysis.

Trial registration. National Project of Hospital Clinical Research (PHRC) Dépistaph, Ministère de la Santé, France.

Study Group Members

Study Group Members

Seventeen French Centres have contributed to this clinical trial. The authors thank: the University Hospital of Saint-Etienne (MH.Fessy1, F.Farizon1, AC.Vautrin2); the “Clinique Mutualiste” of Saint-Etienne (JP.Passot1, JP.Fayard1, F.Chalencon1, JM.Semay1, L.Dupre La Tour1, L.Beguin1, R.Meley2); the “Centre Hospitalier Privé de la Loire of Saint-Etienne” (A.Mesguich1, DG.Avet1, PH.Charlier1, M.Rousson2); the “Clinique du Parc” of Saint-Etienne (L.Charmion1, E.Puech2); the Military Hospital Desgenettes of Lyon (JP.Romanet1, F.Rongiéras1, P.Lainé1, F.Chauvin1, M.Branfaux1, B.Chevalier2); the University Hospital of Lyon (J.Bejuy1, JP.Carret1, P.Neyret1, F.Lecuire1, J.Rubini1, M.Basso1, I.Benareau1, P.Girardo2, S.Tigaud2, J.Carrere2, C.Galabert2, D.Peyramond3); the “Clinique Sainte-Anne” of Lyon (M.Bonnin1, JP.Hager1, P.Chambat1, A.François2); the University Hospital of Grenoble (P.Merloz1, J.Croize2, JP.Stahl3); the “Clinique des Cévennes” of Annonay (A.Mironneau1, E.Forestier2); the Hospital of Montbrison (P.Girardin1, F.Crepet2); the Hospital of Roanne (A.Durand1, W.Tohoubi1, D.Raou1, M.Boyer2); the “Clinique Orthopédique Médico-Chirurgicale” of Dracy-le-Fort (Dr. P.Deroche1, G.Deschamps1, S.Rizk1, C.Chol1, P.Ragois1, C.Pomel2); the University Hospital of Nimes (G.Asencio1, R.Bertin1, N.Bouziges2, A.Sotto3); the “Clinique Clairval” of Marseille (D.Prost1, JF.Thiery1, M.Chickly1, A.Merabet-Sigwalt2); and the University Hospital of Nice (P.Boileau1, G.Armando1, H.Carsenti2, P.Dellamonica3).

1 = Orthopaedic Surgeon; 2 = Microbiologist; 3 = Infectious Diseases Consultant.

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Berthelot, P., Grattard, F., Cazorla, C. et al. Is nasal carriage of Staphylococcus aureus the main acquisition pathway for surgical-site infection in orthopaedic surgery?. Eur J Clin Microbiol Infect Dis 29, 373–382 (2010). https://doi.org/10.1007/s10096-009-0867-5

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  • DOI: https://doi.org/10.1007/s10096-009-0867-5

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