Prior Staphylococcus Aureus Nasal Colonization: A Risk Factor for Surgical Site Infections Following Decolonization.
BACKGROUND
Staphylococcus aureus (S aureus) decolonization regimens are being used to mitigate the risk of surgical site infection (SSI). However, their efficacy is controversial, with mixed results reported in the literature.


METHODS
Before undergoing primary total knee arthroplasty (TKA), total hip arthroplasty (THA), or spinal fusion, 13,828 consecutive patients were screened for nasal S aureus and underwent a preoperative decolonization regimen. Infection rates of colonized and noncolonized patients were compared using unadjusted logistic regression. An adjusted regression analysis was performed to determine independent risk factors for SSI.


RESULTS
The rate of SSI in colonized patients was 4.35% compared with only 2.39% in noncolonized patients. In our TKA cohort, unadjusted logistic regression identified S aureus colonization to be a significant risk factor for SSI (odds ratio [OR], 2.9; P < 0.001). After controlling for other potential confounders including age, body mass index, tobacco use, and American Society of Anesthesiologists score, an SSI was 3.8 times more likely to develop in patients colonized with S aureus (OR, 3.8; P = 0.0025). The THA and spine colonized patients trended toward higher risk in both unadjusted and adjusted models; however, the results were not statistically significant.


CONCLUSIONS
The results of our study suggest that decolonization may not be fully protective against SSI. The risk of infection after decolonization is not lowered to the baseline of a noncolonized patient.


METHODS
Level IV.
From the Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY.
Nicholas
N
Ramos
Anna
A
Stachel
Michael
M
Phillips
Jonathan
J
Vigdorchik
James
J
Slover
Joseph A
JA
Bosco
D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
D000891:Anti-Infective Agents, Local