title: Preoperative decolonization effective at reducing staphylococcal colonization in total joint arthroplasty patients.
abstract: Staphylococcus decolonization prior to surgery is used to prevent surgical site infections (SSIs) after total joint arthroplasty (TJA). To determine if current treatment protocols result in successful decolonization of methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA), 106 consecutive patients were screened for nasal MSSA/MRSA colonization pre-operatively and on the day of surgery. Colonized patients used intranasal mupirocin twice a day and chlorhexidine showers daily 5 days prior to surgery. Pre-operatively, 24 joints (22.0%) were positive for MSSA colonization and 5 joints (4.6%) were positive for MRSA colonization. On the day of surgery, 3 joints (2.8%) who underwent decolonization were positive for MSSA colonization and 0 joints were positive for MRSA colonization. The reduction in MSSA colonization was significant (P<0.001), while the eradication of MRSA colonization approached statistical significance (P=0.063). Current decolonization protocols using intranasal mupirocin and chlorhexidine washes are effective for reducing MRSA/MSSA colonization.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Chen
authors.forename: Alma E
authors.initials: AE
authors.lastname: Heyl
authors.forename: Peter Z
authors.initials: PZ
authors.lastname: Xu
authors.forename: Nalini
authors.initials: N
authors.lastname: Rao
authors.forename: Brian A
authors.initials: BA
authors.lastname: Klatt
mesh_terms: D000281:Administration, Intranasal; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001494:Baths; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000627:therapeutic use*; D011300:Preoperative Care; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D016712:Mupirocin; D002710:Chlorhexidine
keywords: Staphylococcus aureus; chlorhexidine; decolonization; mupirocin; screening; total joint arthroplasty