title: Is preoperative staphylococcal decolonization efficient in total joint arthroplasty.
abstract: Intranasal carrier status of Methicillin-sensitive Staphylococcus aureus (MSSA), and Methicillin-resistant Staphylococcus aureus (MRSA) has been shown to be a significant risk factor for developing surgical site infections. To determine if current treatment protocol for positive nasal screen was effective at decolonizing carriers 289 consecutive patients undergoing primary or revision total joint arthroplasty were screened preoperatively. Those patients with positive cultures were treated with a 5-day course of intranasal mupirocin. Preoperatively 44 (15.2%) patients tested positive for MSSA colonization, and 12 (4.2%) patients for MRSA. Testing on the day of surgery revealed 15 (5.2%) patients with MSSA positive cultures, and 1 (0.35%) patient with a MRSA positive culture. Reduction of MSSA and MRSA colonization was statistically significant (P=0.0341, P=0.0073 respectively). Our overall results indicate that our current decolonization protocol with nasal mupirocin was effective in reducing MSSA and MRSA colonization, although a significant number of patients remained positive for MSSA.
authors.affiliation: Department of Orthopaedic Surgery, Joint replacement Service, University of California, Irvine, Orange, California.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Moroski
authors.affiliation: Department of Orthopaedic Surgery, Joint replacement Service, University of California, Irvine, Orange, California.
authors.forename: Spencer
authors.initials: S
authors.lastname: Woolwine
authors.affiliation: Department of Orthopaedic Surgery, Joint replacement Service, University of California, Irvine, Orange, California.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D002353:Carrier State / Q000188:drug therapy; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage*; D009296:Nasal Cavity / Q000382:microbiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin
keywords: Staphylococcus aureus; methicillin-resistant Staphylococcus aureus; methicillin-sensitive; mupirocin; nasal decolonization; total joint arthroplasty