Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus? A part-retrospective case-control study in a Scottish hospital.
With recent focus on methicillin-resistant Staphylococcus aureus (MRSA) screening, methicillin-susceptible S. aureus (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery.



We broadened MRSA screening to include MSSA for elective orthopaedic patients. Preoperative decolonisation was offered if appropriate. Elective and trauma patients were audited for staphylococcal infection during 2 6-month periods (A: January to June 2013 MRSA screening; B: January to June 2014 MRSA and MSSA screening). Trauma patients are not screened presurgery and provided a control. MSSA screening costs of a modelled cohort of 500 elective patients were offset by changes in number and costs of MSSA infections to demonstrate the change in total health service costs.



Trauma patients showed similar infection rates during both periods (p=1). In period A, 4 (1.72%) and 15 (6.47%) of 232 elective patients suffered superficial and deep MSSA infections, respectively, with 6 superficial (2%) and 1 deep (0.3%) infection among 307 elective patients during period B. For any MSSA infection, risk ratios were 0.95 (95% CI 0.41 to 2.23) for trauma and 0.28 (95% CI 0.12 to 0.65) for elective patients (period B vs period A). For deep MSSA infections, risk ratios were 0.58 (95% CI 0.20 to 1.67) for trauma and 0.05 (95% CI 0.01 to 0.36) for elective patients (p=0.011). There were 29.12 fewer deep infections in the modelled cohort of 500 patients, with a cost reduction of £831 678 for 500 patients screened.



MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits.
Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, Glasgow, UK.
Stephanie J
SJ
Dancer
Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, Glasgow, UK.
Fraser
F
Christison
Department of Orthopaedics, Hairmyres Hospital, NHS Lanarkshire, Glasgow, UK.
Attaolah
A
Eslami
Department of Orthopaedics, Hairmyres Hospital, NHS Lanarkshire, Glasgow, UK.
Alberto
A
Gregori
Department of Orthopaedics, Hairmyres Hospital, NHS Lanarkshire, Glasgow, UK.
Roslyn
R
Miller
Department of Orthopaedics, Hairmyres Hospital, NHS Lanarkshire, Glasgow, UK.
Kumar
K
Perisamy
Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK Health Protection Scotland, Glasgow, UK International Prevention Research Institute, Lyon, France.
Chris
C
Robertson
Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Nick
N
Graves
D002353:Carrier State / Q000175:diagnosis; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000191:economics*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012606:Scotland; D013203:Staphylococcal Infections / Q000175:diagnosis*
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