title: Staphylococcus aureus nasal decolonization in joint replacement surgery reduces infection.
abstract: Surgical site infections (SSIs) with Staphylococcus aureus are a recognized adverse event of hip and knee replacements. We evaluated the impact of a program to detect S. aureus nasal carriers before surgery with preoperative decolonization (using mupirocin twice daily for 5 days prior to surgery) of carriers. Nasal swab samples were obtained from patients prior to surgery from 8/1/2003 through 2/28/2005. Samples were tested using real-time PCR technology to detect S. aureus. The group that developed S. aureus SSI was compared to a combined concurrent and historical control for one year following the operation. S. aureus caused 71% of SSIs in the combined control groups. Of the 1495 surgical candidates evaluated, 912 (61.0%) were screened for S. aureus; 223 of those screened (24.5%) were positive and then decolonized with mupirocin. Among the 223 positive and decolonized patients, three (1.3%) developed a SSI. Among the 689 screen-negative patients, four (0.6%) developed SSIs for an overall rate of 0.77%. Among the 583 control patients who were not screened or decolonized, 10 (1.7%) developed S. aureus SSIs. SSIs from other organisms were 0.44% and 0.69%, respectively.
  
  
  METHODS
  Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Evanston Northwestern Healthcare, Evanston, IL, USA. dhacek@enh.org
authors.forename: Donna M
authors.initials: DM
authors.lastname: Hacek
authors.forename: William J
authors.initials: WJ
authors.lastname: Robb
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Paule
authors.forename: James C
authors.initials: JC
authors.lastname: Kudrna
authors.forename: Van Paul
authors.initials: VP
authors.lastname: Stamos
authors.forename: Lance R
authors.initials: LR
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods*; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D002353:Carrier State / Q000175:diagnosis / Q000188:drug therapy*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage; D009296:Nasal Cavity / Q000382:microbiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin