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Prevalence of Staphylococcus aureus colonization in patients for total joint arthroplasty in South Africa
Jurek Rafal Tomasz Pietrzak1, Zia Maharaj2, Lipalo Mokete3
1Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Jubilee Street, Parktown, Johannesburg, Gauteng, 2193, South Africa. jrtpietrzak@yahoo.com.
Background:
Periprosthetic joint infections (PJIs) are a major source of morbidity and mortality for patients undergoing total joint arthroplasty (TJA). Staphylococcus aureus (S. aureus) colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in S. aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of S. aureus colonization in patients awaiting TJA in South Africa.
Methods:
We prospectively assessed 119 patients awaiting total knee arthroplasty and total hip arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for S. aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t tests, Fisher's exact tests, and chi-square analyses.
Results:
The overall prevalence of methicillin-sensitive S. aureus colonization was 31.9% (n = 38). There were no patients colonized with methicillin-resistant S. aureus. Nasal swabs returned a yield of 81.6% (n = 31), with groin swabs and axillary swabs at 39.5% (n = 15) and 28.9% (n = 11), respectively. Eradication was successful in 94.74% (n = 36) after 5 days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n = 9). The 30-day readmission rate in the S. aureus-colonized group was 7.9% (n = 3) as opposed to 7.4% (n = 6) in the non-colonized cohort. There were no 60- and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years.
Conclusions:
The rate of S. aureus colonization in patients undergoing elective TJA in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.
Insights
Staphylococcus aureus colonization affects 31.9% of patients awaiting joint replacement surgery in South Africa. A combination of intranasal mupirocin and chlorhexidine effectively eradicated S. aureus, reducing infection risk.
Area of Science:
- Orthopedics
- Infectious Diseases
- Public Health
Background:
- Periprosthetic joint infections (PJIs) are a significant cause of morbidity and mortality after total joint arthroplasty (TJA).
- Staphylococcus aureus (S. aureus) colonization is a modifiable risk factor for PJIs, with higher infection rates in carriers.
- Data on S. aureus colonization prevalence in developing countries undergoing TJA is limited.
Purpose of the Study:
- To determine the prevalence of S. aureus colonization in patients scheduled for TJA in South Africa.
- To assess the efficacy of a combined intranasal mupirocin and chlorhexidine body wash treatment for S. aureus decolonization.
- To provide baseline data for future studies on risk factors and post-operative outcomes in this population.
Main Methods:
- Prospective assessment of 119 patients undergoing total knee or hip arthroplasty.
- Screening of S. aureus colonization at nasal, groin, and axillary sites.
- Treatment of positive cultures with intranasal mupirocin and chlorhexidine body wash, followed by statistical analysis.
Main Results:
- Overall S. aureus colonization prevalence was 31.9% (n=38), with no methicillin-resistant S. aureus (MRSA) detected.
- Nasal swabs yielded the highest S. aureus detection rate (81.6%).
- Decolonization was highly successful (94.74% after 5 days, 100% after repeat treatment), with low complication and readmission rates.
Conclusions:
- The prevalence of S. aureus colonization in South African patients undergoing TJA is comparable to developed countries.
- Combined intranasal mupirocin and chlorhexidine is an effective decolonization strategy.
- Further research with larger cohorts is recommended to identify risk factors and post-operative sequelae.
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