Is preoperative staphylococcal decolonization efficient in total joint arthroplasty

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.