title: Prevalence of MRSA colonization in an adult urban Indian population undergoing orthopaedic surgery.
abstract: BACKGROUND
  Orthopaedic surgery is technically demanding, implant dependant and expensive. Infection translates into a prolonged morbidity and long-term use of antibiotics. The most common organism involved in osteo-articular infections is Staphylococcus aureus, and colonizes the anterior nares of 25-30% of the population. Carriers are at higher risk for staphylococcal infections after invasive medical or surgical procedures. Prevalence of methicillin resistant Staphylococcus aureus (MRSA) has not been assessed in patients admitted for orthopaedic surgery in the Indian setting.
  
  
  OBJECTIVE
  To assess the preoperative prevalence of MRSA colonization in adult patients undergoing orthopaedic surgery in urban India.
  
  
  METHODS
  This is a retrospective analysis of patients from 2009 to 2013. A total of 1550 patients admitted for orthopaedic surgery were preoperatively screened with nasal and axillary swabs for MRSA. Swab-positive patients were treated with intranasal mupirocin ointment for 3 days followed by a repeat swab. A record was made of hospitalization in the year prior to surgery and the occurrence of surgical site infection (SSI).
  
  
  RESULTS
  A total of 690 males and 860 females had been screened for MRSA using an inexpensive kit costing 500 Indian rupees. For MRSA, 7/1550 (0.45%) nasal swabs were positive. No patient since 2009 has had a SSI with MRSA.
  
  
  CONCLUSIONS
  MRSA screening prior to orthopaedic surgery is a valuable and cost effective preoperative investigation even though the incidence is low. Mupirocin is effective in clearing MRSA from the nares and maybe used for 3 days to obtain elimination of the bacteria.
authors.affiliation: Director Professional Services, Head of Surgery, Consultant Orthopaedics Trauma & Arthroplasty, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Agarwala
authors.affiliation: Consultant Orthopaedics Trauma & Arthroplasty, Lad's Bone & Joint Clinic, 4th Floor, Kailas Darshan, Kennedy Bridge, Nana Chowk, Mumbai 400026, India.
authors.forename: Dnyanesh
authors.initials: D
authors.lastname: Lad
authors.affiliation: Consultant Orthopaedics Trauma & Musculoskeletal Infection, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Agashe
authors.affiliation: Associate Consultant Orthopaedics Trauma & Arthroplasty, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016, India.
authors.forename: Anshul
authors.initials: A
authors.lastname: Sobti
keywords: MRSA; MRSA in orthopaedic surgery; Mupirocin; Screening; Surgical site infection