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Cost Efficacy of Methicillin-Resistant Staphylococcus aureus Decolonization With Intranasal Povidone-Iodine

G Ryan Rieser¹, Joseph T Moskal¹

¹Virginia Tech - Carilion Clinic, Institute for Orthopaedics and Neurosciences, Roanoke, VA.

The Journal of Arthroplasty

|March 7, 2018

Abstract

Background:

With increasing rates of virulent drug resistant organisms, MRSA (methicillin-resistant Staphylococcus aureus) decolonization has been demonstrated to decrease infection rates. Recent research has shown the antiseptic povidone-iodine to be equally effective and potentially cost saving compared to intranasal mupirocin. This study's purpose is to evaluate the incidence of MRSA colonization in a more rural community-based population, rates of infection on a mupirocin decolonization protocol, and develop a cost analysis model to compare costs of utilizing povidone-iodine.

Methods:

Utilizing over 4 years of data, the incidence of MRSA decolonization of consecutive total knee and hip arthroplasties, as well as the rates of infection of patients uncolonized, colonized with successful decolonization, and unsuccessful decolonization were evaluated. Utilizing these data, cost data, and known infection rate utilizing povidone-iodine decolonization, a cost analysis model was developed.

Results:

Of the 5584 cases with MRSA data at a single institution, only 3.5% tested positive for intranasal MRSA. Of those patients, 69% were successfully decolonized. Of the 3864 cases with infection data, 21 sustained a surgical site infection within 90 days (0.54%). Of these patients, all tested negative for intranasal MRSA initially and therefore did not undergo the decolonization protocol. The cost analysis predicts a potential savings of $74.72 per patient at our institution to use a global intranasal povidone-iodine protocol prior to total joint arthroplasty.

Conclusion:

Even with a lower incidence of MRSA than typically reported, utilization of intranasal povidone-iodine would potentially save $74.42 per patient.

Insights

Intranasal povidone-iodine effectively decolonizes methicillin-resistant Staphylococcus aureus (MRSA) and offers cost savings compared to mupirocin. This approach could save $74.42 per patient in joint arthroplasty procedures.

Area of Science:

Infectious Disease
Surgical Site Infections
Antimicrobial Resistance

Background:

Rising rates of drug-resistant organisms like MRSA necessitate effective decolonization strategies.
Povidone-iodine shows comparable efficacy to mupirocin for MRSA decolonization and may be more cost-effective.
Evaluating MRSA colonization and decolonization protocols is crucial for preventing infections, particularly in surgical settings.

Purpose of the Study:

To assess MRSA colonization incidence in a rural community population undergoing total joint arthroplasty.
To evaluate surgical site infection rates associated with a mupirocin decolonization protocol.
To develop a cost-analysis model comparing povidone-iodine and mupirocin for MRSA decolonization.

Main Methods:

Analysis of over four years of data on MRSA decolonization in total knee and hip arthroplasties.
Evaluation of infection rates in patients based on MRSA colonization and decolonization success.
Development of a cost analysis model incorporating institutional data and known povidone-iodine efficacy.

Main Results:

A low incidence of intranasal MRSA (3.5%) was observed in 5584 cases, with 69% successful decolonization.
Surgical site infections occurred in 0.54% of 3864 cases, with all infected patients initially testing negative for MRSA.
Cost analysis predicted potential savings of $74.72 per patient using intranasal povidone-iodine.

Conclusions:

Intranasal povidone-iodine presents a cost-effective alternative for MRSA decolonization in joint arthroplasty.
Even with lower MRSA prevalence, povidone-iodine offers significant potential cost savings.
Implementing povidone-iodine protocols could reduce healthcare costs associated with MRSA decolonization.

Read full analysis

Keywords:

MRSA complication cost infection primary hip and knee arthroplasty

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