Methicillin-resistant staphylococcal infections: an important consideration for orthopedic surgeons

Postoperative infections in joint prostheses and fracture-fixation devices commonly involve both MRSA and methicillin resistant coagulase-negative staphylococcus. In addition, community-acquired MRSA has also become an important consideration when infected patients are admitted to the hospital from the community. Preoperative colonization with MRSA and methicillin resistant coagulase-negative staphylococcus increases the risk of postoperative surgical site infections in orthopedic patients. Up to 5.3% of orthopedic patients are colonized with these organisms on hospital admission. Screening and decolonization of methicillin resistant staphylococci decrease the incidence of postoperative surgical site infections in the orthopedic patient. This may be particularly important in orthopedic implants given the difficulty encountered in treating infected prosthesis. Current US guidelines advocate screening for methicillin resistant staphylococci only when risk factors are present. Growing evidence suggests that screening and decolinization of all patients having elective orthopedic procedures, especially those including prosthetic implants, will decrease the incidence of postoperative infections. The infected prosthesis may be potentially salvaged if the clinical manifestations of infection have been present for < or = 10 days, the implant is stable, and the etiologic organisms are susceptible to oral antibiotics.