Staphylococcus aureus nasal colonization in preoperative orthopaedic outpatients.
Nasal colonization with Staphylococcus aureus (SA) increases the risk of surgical site infection (SSI). We first (1) determined the prevalence of asymptomatic nasal colonization with SA, (2) assessed trends in methicillin resistance with time, (3) ascertained risk factors for nasal colonization; and (4) correlated SSI to nasal colonization status and procedure. We performed a cross-sectional analysis of SA nasal colonization among healthy preoperative orthopaedic outpatients between 2003-2005 who were within 2 weeks of surgery. Of 284 patients, 86 (30%) carried SA; of these, 81 (94%) were colonized with methicillin-sensitive and five (6%) with methicillin-resistant SA (MRSA). Total SA colonization increased from 25/78 (32%) in 2003 to 37/97 (38%) in 2005, and colonization with MRSA increased from 0/78 (0%) to four of 97 (4%), respectively. We found no associations between nasal carriage and demographics or procedures. Surgical site infection occurred in nine of 282 (3%), four of which were attributable to SA; these included 0/43 (0%) carriers who received decolonization with 2% mupirocin, two of 43 (4.7%) who declined decolonization, and two of 196 (1.0%) who were noncarriers. Nasal colonization with SA, including MRSA, among preoperative orthopaedic outpatients is increasing and their rates reflect community rates. Knowledge of colonization status may be important in decolonization, choosing perioperative or any subsequent empiric antibiotics.
Department of Medicine, Division of Infectious Diseases, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA. connie.price@dhha.org
Connie Savor
CS
Price
Allison
A
Williams
Giby
G
Philips
Michael
M
Dayton
Wade
W
Smith
Steven
S
Morgan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015169:Colony Count, Microbial; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000601:surgery; D009297:Nasal Mucosa / Q000382:microbiology*; D019637:Orthopedic Procedures; D010045:Outpatients; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000254:growth & development* / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology