title: Preoperative screening/decolonization for Staphylococcus aureus to prevent orthopedic surgical site infection: prospective cohort study with 2-year follow-up.
abstract: We quantified surgical site infections (SSIs) after preoperative screening/selective decolonization before elective total joint arthroplasty (TJA) with 2-year follow-up and 2 controls. Concurrent controls (n = 2284) were patients of surgeons not participating in screening/decolonization. Preintervention controls (n = 741) were patients of participating surgeons who underwent TJA the previous year. Staphylococcus aureus nasal carriers (321/1285 [25%]) used intranasal mupirocin and chlorhexidine baths as outpatients. Staphylococcal SSIs occurred in no intervention patients (0/321) and 19 concurrent controls. If all SSIs occurred in carriers and 25% of controls were carriers, staphylococcal SSI rate would have been 3.3% in controls (19/571; P = .001). Overall SSI rate decreased from 2.7% (20/741) in preintervention controls to 1.2% (17/1440) in intervention patients (P = .009). Preoperative screening/selective decolonization was associated with fewer SSIs after elective TJA.
authors.affiliation: Department of Medicine, Division of Infectious Disease, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15206, USA.
authors.forename: Nalini
authors.initials: N
authors.lastname: Rao
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Cannella
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Crossett
authors.forename: Adolph J
authors.initials: AJ
authors.lastname: Yates
authors.forename: Richard L
authors.initials: RL
authors.lastname: McGough
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Hamilton
mesh_terms: D000281:Administration, Intranasal; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D005500:Follow-Up Studies; D006621:Hip Joint / Q000382:microbiology / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000382:microbiology / Q000601:surgery; D008403:Mass Screening; D016712:Mupirocin / Q000008:administration & dosage / Q000627:therapeutic use; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin; D002710:Chlorhexidine