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Efficacy of mupirocin, neomycin and octenidine for nasal Staphylococcus aureus decolonisation: a retrospective cohort
J Allport1, R Choudhury2, P Bruce-Wootton2
1Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK. j.allport@nhs.net.
Background:
Periprosthetic joint infection (PJI) causes significant morbidity. Methicillin sensitive Staphylococcus aureus (MSSA) is the most frequent organism, and the majority are endogenous. Decolonisation reduces PJIs but there is a paucity of evidence comparing treatments. Aims; compare 3 nasal decolonisation treatments at (1) achieving MSSA decolonisation, (2) preventing PJI.
Methods:
Our hospital prospectively collected data on our MSSA decolonisation programme since 2013, including; all MSSA carriers, treatment received, MSSA status at time of surgery and all PJIs. Prior to 2017 MSSA carriers received nasal mupirocin or neomycin, from August 2017 until August 2019 nasal octenidine was used.
Results:
During the study period 15,958 primary hip and knee replacements were performed. 3200 (20.1%) were MSSA positive at preoperative screening and received decolonisation treatment, 698 mupirocin, 1210 neomycin and 1221 octenidine. Mupirocin (89.1%) and neomycin (90.9%) were more effective at decolonisation than octenidine (50.0%, P < 0.0001). There was no difference in PJI rates (P = 0.452).
Conclusions:
Mupirocin and neomycin are more effective than octenidine at MSSA decolonisation. There was poor correlation between the MSSA status after treatment (on day of surgery) and PJI rates. Further research is needed to compare alternative MSSA decolonisation treatments.
Insights
Nasal mupirocin and neomycin effectively decolonize Methicillin-sensitive Staphylococcus aureus (MSSA) carriers, outperforming octenidine. However, decolonization success did not correlate with reduced periprosthetic joint infection (PJI) rates.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Periprosthetic joint infection (PJI) is a significant complication following joint replacement surgery.
- Methicillin-sensitive Staphylococcus aureus (MSSA) is the most common pathogen causing PJIs, often originating from endogenous sources.
- Nasal decolonization is a strategy to reduce PJIs, but comparative evidence for different treatments is limited.
Purpose of the Study:
- To compare the efficacy of three nasal decolonization treatments for MSSA carriers.
- To evaluate the impact of these treatments on preventing PJI after hip and knee replacement.
Main Methods:
- Prospective data collection on an MSSA decolonization program since 2013.
- Comparison of nasal mupirocin, neomycin, and octenidine treatments for MSSA carriers undergoing primary hip and knee replacements.
- Analysis of MSSA carrier status, treatment received, and subsequent PJI development.
Main Results:
- Mupirocin (89.1%) and neomycin (90.9%) achieved significantly higher MSSA decolonization rates compared to octenidine (50.0%).
- No significant difference in PJI rates was observed between the treatment groups (P=0.452).
- A total of 15,958 primary hip and knee replacements were analyzed, with 3200 patients identified as MSSA carriers.
Conclusions:
- Nasal mupirocin and neomycin are superior to octenidine for MSSA decolonization.
- The correlation between post-treatment MSSA status and PJI rates was poor.
- Further research is warranted to compare alternative MSSA decolonization strategies.
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