Preoperative decolonization effective at reducing staphylococcal colonization in total joint arthroplasty patients

Area of Science:

• Infectious Disease
• Orthopedic Surgery
• Microbiology

Background:

• Surgical site infections (SSIs) are a risk after total joint arthroplasty (TJA).
• Staphylococcus colonization, including methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA), is a primary cause of SSIs.
• Pre-operative decolonization aims to reduce bacterial load and prevent post-operative infections.

Purpose of the Study:

• To evaluate the efficacy of current decolonization protocols in eliminating nasal MSSA and MRSA colonization before TJA.
• To assess the impact of intranasal mupirocin and chlorhexidine washes on bacterial carriage in patients undergoing TJA.

Main Methods:

• 106 patients undergoing TJA were screened for nasal MSSA/MRSA colonization pre-operatively and on the day of surgery.
• Patients with positive colonization received intranasal mupirocin twice daily and daily chlorhexidine showers for 5 days prior to surgery.
• Pre- and post-treatment colonization rates were compared using statistical analysis.

Main Results:

• Pre-operatively, 22.0% of patients were colonized with MSSA and 4.6% with MRSA.
• On the day of surgery, MSSA colonization decreased to 2.8% (P<0.001) and MRSA colonization decreased to 0% (P=0.063).
• The decolonization protocol demonstrated significant reduction in MSSA and near-significant reduction in MRSA.

Conclusions:

• Current decolonization protocols involving intranasal mupirocin and chlorhexidine are effective in reducing MSSA and MRSA colonization prior to TJA.
• These protocols contribute to infection control strategies in orthopedic surgery.
• Further research may be warranted to achieve statistically significant eradication of MRSA.