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Published on: December 3, 2017
Screening of MRSA colonization in patients undergoing total joint arthroplasty
A M Valverde Villar1, J Gutiérrez Del Álamo Oms1, I Neira Borrajo1
1Department of Orthopaedic Surgery, Hospital Universitario Santa Cristina, Madrid, Spain.
Background:
Periprosthetic infection is commonly caused by Staphylococcus aureus and, if resistant to methicillin (MRSA), is associated with increase in severity and costs to patient and healthcare systems. MRSA colonizes 1-5% of the population, therefore using a screening and decolonisation protocol the risk of periprosthetic infection could be reduced. The objective of our study is to report the results of a preoperative MRSA screening and management protocol utilised at our hospital.
Methods:
All patients undergoing a total joint arthroplasty at our hospital were preoperatively screened for MRSA colonization with swab samples of five different locations. Exposure to risk factors were investigated in colonised patients and they were treated for 5 days prior surgery with nasal mupirocin, chlorhexidine sponges and oral tablets.
Results:
During the 48 months of the study, MRSA colonisation was identified in 22 (1.01%) of 2188 patients operated. The culture was positive only in the nasal swab in 55 patients. In five patients the nasal culture was negative, but they had another positive swab culture (three in the groin and two perianal). None of the patients reported a history of recent antibiotic treatment or hospitalization.
Conclusion:
At our institution, the prevalence of MRSA colonisation is 1.01% in patients undergoing hip and knee arthroplasty. Interestingly, our screening protocol included samples from five different anatomic locations, and it is important to highlight that we found patients with negative nares culture and positive cultures in other locations. Therefore, the number of carriers may be underdiagnosed if only nasal samples are obtained.
Level Of Evidence:
IV.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) colonization affects 1.01% of patients undergoing joint arthroplasty. Screening multiple body sites, not just the nose, is crucial for accurate MRSA carrier detection to prevent periprosthetic infections.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infection (PJI) is frequently caused by Staphylococcus aureus, particularly methicillin-resistant Staphylococcus aureus (MRSA).
- MRSA infections lead to increased severity, costs, and poorer patient outcomes.
- MRSA colonization affects 1-5% of the general population, presenting a significant risk factor for PJI.
Purpose of the Study:
- To evaluate the effectiveness of a preoperative MRSA screening and decolonization protocol.
- To determine the prevalence of MRSA colonization in patients undergoing total joint arthroplasty.
- To assess the diagnostic yield of multi-site versus single-site (nasal) screening.
Main Methods:
- A prospective study involving 2188 patients undergoing total joint arthroplasty.
- Preoperative screening for MRSA colonization using swab samples from five anatomical locations.
- MRSA-colonized patients received a 5-day preoperative treatment regimen including nasal mupirocin, chlorhexidine sponges, and oral antibiotics.
Main Results:
- MRSA colonization was identified in 22 (1.01%) of the 2188 patients.
- Nasal swabs alone yielded positive results in 55 patients.
- Five patients had negative nasal cultures but positive cultures from other sites (groin, perianal), indicating potential underdiagnosis with nasal screening alone.
Conclusions:
- The prevalence of MRSA colonization in patients undergoing hip and knee arthroplasty at this institution is 1.01%.
- Screening multiple anatomical sites is essential, as relying solely on nasal swabs can lead to underestimation of MRSA carrier status.
- Implementing a comprehensive screening protocol can help mitigate the risk of MRSA periprosthetic infections.
