Positive Preoperative Colonization With Methicillin Resistant Staphylococcus Aureus Is Associated With Inferior...

Area of Science:

• Orthopedic Surgery
• Infectious Disease Control
• Patient Safety

Background:

• Preoperative nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a potential risk factor for surgical site infections.
• The impact of MRSA colonization on total joint arthroplasty (TJA) outcomes remains incompletely understood.
• Evaluating TJA complications based on preoperative staphylococcal colonization status is crucial for patient management.

Purpose of the Study:

• To assess the association between preoperative nasal MRSA colonization and complications following TJA.
• To compare surgical outcomes in TJA patients stratified by MRSA, MSSA, and negative staphylococcal colonization status.
• To inform risk stratification and patient counseling for TJA procedures.

Main Methods:

• Retrospective analysis of 33,854 TJA patients (2011-2022) with preoperative nasal cultures.
• 1:1:1 propensity matching to create three groups: MRSA positive (MRSA+), methicillin-sensitive S. aureus positive (MSSA+), and negative (MSSA/MRSA-).
• MRSA+ and MSSA+ patients received decolonization; MRSA+ also received vancomycin. Outcomes were compared across groups.

Main Results:

• MRSA+ patients experienced longer hospital stays (P=.008) and lower home discharge rates (P=.003).
• Higher 30-day (P=.030) and 90-day (P=.033) readmission rates were observed in MRSA+ patients.
• MRSA+ patients had increased rates of all-cause (P=.020), aseptic (P=.025), and septic (P=.049) revisions compared to other groups.

Conclusions:

• Despite perioperative decolonization, MRSA+ TJA patients exhibit worse outcomes, including longer stays, higher readmissions, and increased revision rates.
• Preoperative MRSA colonization status is a significant factor influencing TJA complications.
• Surgeons should incorporate preoperative MRSA status into risk counseling for TJA candidates.