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Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One

S T J Tsang1, M P McHugh2, D Guerendiain2

  • 1Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK and School of Biological Sciences, University of Edinburgh, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK jerry.tsang@ed.ac.uk.

Bone & Joint Research
|January 14, 2018
PubMed
Abstract

Insights

Standard S. aureus culturing methods miss one-third of nasal carriers, potentially leading to infections. Alternative diagnostic methods in preoperative screening could prevent thousands of infections and save millions in healthcare costs.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Surgical Site Infection Prevention

Background:

  • Nasal carriage of Staphylococcus aureus (S. aureus), including methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) strains, increases the risk of healthcare-associated infections.
  • Limited national screening policies for S. aureus exist despite WHO recommendations, highlighting a gap in infection control strategies.

Purpose of the Study:

  • To evaluate the diagnostic performance of molecular and culture techniques for S. aureus screening.
  • To identify discrepancies between diagnostic methods and their causes.
  • To model the impact of different diagnostic techniques on S. aureus detection in orthopaedic patients.

Main Methods:

  • Paired nasal swabs were collected from 273 orthopaedic outpatients scheduled for joint arthroplasty.
  • Samples were analyzed using polymerase chain reaction (PCR) assay and S. aureus culture.

Main Results:

  • The prevalence of MSSA nasal colonization ranged from 22.4% to 35.6%.
  • Standard direct culturing methods significantly underestimated S. aureus prevalence (p=0.005), failing to detect the bacteria in approximately one-third of patients.

Conclusions:

  • Alternative diagnostic methods to direct culture in preoperative S. aureus screening could prevent an estimated 5000 to 8000 surgical site infections annually in the US and UK.
  • Implementing improved screening could save approximately $140 million to $950 million in treatment costs annually in the US and UK combined.
Keywords:
Periprosthetic joint infectionStaphylococcus aureusSurgical site infection

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