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Is preoperative staphylococcal decolonization efficient in total joint arthroplasty.

Nathan M Moroski1, Spencer Woolwine1, Ran Schwarzkopf1

  • 1Department of Orthopaedic Surgery, Joint replacement Service, University of California, Irvine, Orange, California.

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|December 3, 2014
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Nasal mupirocin effectively reduced Methicillin-sensitive Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA) colonization in surgical patients. However, a notable number of patients still carried MSSA post-treatment.

Keywords:
Staphylococcus aureusmethicillin-resistant Staphylococcus aureusmethicillin-sensitivemupirocinnasal decolonizationtotal joint arthroplasty

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Surgical Infection Prevention

Background:

  • Intranasal carriage of Staphylococcus aureus (MSSA and MRSA) is a key risk factor for surgical site infections.
  • Effective decolonization strategies are crucial for mitigating infection risk in patients undergoing surgery.

Purpose of the Study:

  • To evaluate the efficacy of a 5-day intranasal mupirocin protocol in decolonizing MSSA and MRSA carriers.
  • To assess the impact of the decolonization protocol on preoperative nasal colonization rates.

Main Methods:

  • Prospective screening of 289 patients undergoing total joint arthroplasty for nasal MSSA/MRSA colonization.
  • Treatment of positive carriers with a 5-day course of intranasal mupirocin.
  • Post-treatment screening on the day of surgery to determine decolonization success.

Main Results:

  • Preoperative screening identified 15.2% MSSA and 4.2% MRSA carriers.
  • Post-treatment, MSSA colonization reduced to 5.2% and MRSA to 0.35%.
  • The reduction in both MSSA and MRSA colonization was statistically significant (P=0.0341 and P=0.0073, respectively).

Conclusions:

  • The intranasal mupirocin protocol significantly reduced MSSA and MRSA nasal colonization.
  • While effective, the protocol did not achieve complete eradication of MSSA colonization in all patients.
  • The findings support the use of intranasal mupirocin for decolonization, with potential for protocol refinement.