Predictors of Staphylococcus aureus Colonization and Results after Decolonization

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Microbiology

Background:

• Protocols for screening and decolonizing Staphylococcus aureus before total joint arthroplasty (TJA) are increasingly common.
• Prosthetic joint infections (PJIs) remain a significant complication following TJA.

Purpose of the Study:

• To evaluate if a Staphylococcus aureus screening and decolonization protocol (mupirocin/vancomycin and chlorhexidine) reduces revision rates compared to chlorhexidine alone.
• To assess the predictive accuracy of clinical criteria for identifying patients colonized with methicillin-susceptible Staphylococcus aureus (MSSA) and/or methicillin-resistant Staphylococcus aureus (MRSA).

Main Methods:

• Retrospective review of electronic medical records for primary TJA patients (n=5,678).
• Comparison between screened (n=3,927) and unscreened (n=1,751) patients, all receiving preoperative chlorhexidine body wipes.
• Screened patients with MSSA/MRSA received mupirocin/vancomycin, respectively, alongside standard preoperative care.

Main Results:

• Screened patients had a 50% lower likelihood of revision due to PJI compared to unscreened patients (p=0.04).
• Multivariate regression models demonstrated poor accuracy in predicting MSSA (AUC=0.58) and MRSA (AUC=0.62) colonization.

Conclusions:

• Routine screening and decolonization of Staphylococcus aureus prior to TJA is supported by these findings.
• Clinical criteria are not reliable for predicting S. aureus colonization in TJA patients.