Nasal Methicillin-Resistant Staphylococcus Aureus Screening in Orthopaedic Patients: We Should Not Ignore...

Area of Science:

• Orthopaedic Surgery
• Infectious Disease Epidemiology
• Microbiology

Background:

• Staphylococcus aureus (S. aureus) is a leading cause of surgical site infections (SSIs) in orthopaedic patients.
• Nasal screening typically focuses on methicillin-resistant S. aureus (MRSA), often overlooking methicillin-sensitive S. aureus (MSSA).
• Understanding the prevalence and risk factors for both MSSA and MRSA colonization is crucial for effective SSI prevention strategies.

Purpose of the Study:

• To determine the prevalence of MSSA and MRSA nasal colonization in orthopaedic patients.
• To identify demographic and comorbidity risk factors associated with S. aureus colonization.
• To evaluate the impact of decolonization protocols on postoperative infection rates.

Main Methods:

• Analysis of prospectively collected data from 3,606 patients undergoing elective orthopaedic procedures (2017-2023).
• Review of nasal screening results and patient demographics to identify colonization prevalence and associated factors.
• Logistic regression models were used to assess risk factors for S. aureus, MRSA, and infection, considering demographic and comorbidity variables.

Main Results:

• The prevalence of MSSA colonization was 26.3% and MRSA colonization was 7.7%.
• Significant risk factors for S. aureus colonization included higher Charlson Comorbidity Index, cardiac disease, uncontrolled hypertension, and coagulopathy.
• Postoperative infection rates at 90 days did not differ between colonized and non-colonized patients, suggesting effective decolonization.

Conclusions:

• The high prevalence of both MSSA and MRSA colonization suggests that universal decolonization protocols for orthopaedic patients may be beneficial.
• Targeted decolonization strategies for high-risk patients should be considered if universal implementation is not feasible.
• Further research into the efficacy and cost-effectiveness of universal decolonization in this patient population is warranted.