Staphylococcus aureus colonization among arthroplasty patients previously treated by a decolonization protocol: a...

Area of Science:

• Orthopedic Surgery
• Infectious Disease Epidemiology
• Microbiology

Background:

• Preoperative screening and decolonization for Staphylococcus aureus (S. aureus) are established practices before total joint arthroplasty (TJA).
• The long-term effectiveness and durability of S. aureus decolonization in TJA patients remain incompletely understood.

Purpose of the Study:

• To determine the prevalence of persistent S. aureus colonization in patients who underwent TJA, despite prior decolonization efforts.
• To assess the rate of S. aureus re-colonization at 3 to 30 months post-TJA.

Main Methods:

• Prospective screening and treatment for nasal S. aureus in 634 TJA patients over two years.
• Follow-up nasal cultures were performed on 58 patients (42%) who initially tested positive for S. aureus (methicillin-sensitive or methicillin-resistant).
• Data collected included patient demographics, TJA type, and time to repeat culture; clonal analysis was not performed.

Main Results:

• Of 58 patients retested, 19 (33%) showed persistent S. aureus colonization.
• The majority of recurrent colonizations (89%) exhibited unchanged antibiotic sensitivity, suggesting persistence over reinfection.
• Thirty-nine patients (67%) were successfully decolonized at follow-up.

Conclusions:

• A substantial proportion (33%) of TJA patients remain colonized with S. aureus months after preoperative decolonization.
• Current decolonization protocols do not guarantee sustained eradication, necessitating awareness among orthopedic surgeons.
• Further investigation is warranted to understand the implications of persistent S. aureus colonization on late TJA infection risk.