title: Low risk despite high endemicity of methicillin-resistant Staphylococcus aureus infections following elective total joint arthroplasty: a 12-year experience.
abstract: Abstract   Background. It is unknown if low rates of arthroplasty infections due to methicillin-resistant Staphylococcus aureus (MRSA) can be achieved in a setting with endemic MRSA (30%).   Methods. We performed a 12-year prospective cohort study (1996-2008) of patients undergoing elective knee and hip joint arthroplasties with long-term follow-up. Retrospective MRSA surveillance was undertaken using electronic databases.   Results. A total of 6,100 total joint arthroplasties (4001 hip; 2099 knee; 441 (7%) revisions) were monitored for a total of 34,281 person-years of follow-up (median 64 months). MRSA carriage was detected in 126 (2.1%) episodes before arthroplasty and in 147 (2.4%) after arthroplasty. Seven (0.11%) deep arthroplasty infections due to MRSA were retrieved for an overall incidence of 2 episodes per 10,000 person-years. Six were primary surgical site infections, while one infection resulted from endocarditis. MRSA colonization pressure was 11,411 MRSA-positive days for a total of 138,044 patient-days (8.3%) among all orthopedic patients.   Conclusion. Institution-wide MRSA endemicity does not necessarily lead to a high MRSA infection risk after elective hip and knee arthroplasty.
authors.affiliation: Orthopedic Surgery Department, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
authors.forename: Anne
authors.initials: A
authors.lastname: Lübbeke
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.forename: Stéphane
authors.initials: S
authors.lastname: Emonet
authors.forename: Luisa
authors.initials: L
authors.lastname: Tovmirzaeva
authors.forename: Americo
authors.initials: A
authors.lastname: Agostinho
authors.forename: Yves
authors.initials: Y
authors.lastname: Longtin
authors.forename: Robin
authors.initials: R
authors.lastname: Peter
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D015331:Cohort Studies; D019353:Endemic Diseases; D006785:Hospitals, University; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013557:Switzerland