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Staphylococcus aureus nasal decolonization in joint replacement surgery reduces infection Hacek DM; Robb WJ; Paule SM; Kudrna JC; Stamos VP; Peterson LRClin Orthop Relat Res 2008[Jun]; 466 (6): 1349-55Surgical site infections (SSIs) with Staphylococcus aureus are a recognized adverse event of hip and knee replacements. We evaluated the impact of a program to detect S. aureus nasal carriers before surgery with preoperative decolonization (using mupirocin twice daily for 5 days prior to surgery) of carriers. Nasal swab samples were obtained from patients prior to surgery from 8/1/2003 through 2/28/2005. Samples were tested using real-time PCR technology to detect S. aureus. The group that developed S. aureus SSI was compared to a combined concurrent and historical control for one year following the operation. S. aureus caused 71% of SSIs in the combined control groups. Of the 1495 surgical candidates evaluated, 912 (61.0%) were screened for S. aureus; 223 of those screened (24.5%) were positive and then decolonized with mupirocin. Among the 223 positive and decolonized patients, three (1.3%) developed a SSI. Among the 689 screen-negative patients, four (0.6%) developed SSIs for an overall rate of 0.77%. Among the 583 control patients who were not screened or decolonized, 10 (1.7%) developed S. aureus SSIs. SSIs from other organisms were 0.44% and 0.69%, respectively. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.|Aged[MESH]|Aged, 80 and over[MESH]|Anti-Bacterial Agents/*administration & dosage[MESH]|Antibiotic Prophylaxis/economics/*methods[MESH]|Arthroplasty, Replacement/*adverse effects[MESH]|Carrier State/diagnosis/*drug therapy[MESH]|Cohort Studies[MESH]|Cost-Benefit Analysis[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Mupirocin/administration & dosage[MESH]|Nasal Cavity/microbiology[MESH]|Retrospective Studies[MESH]|Staphylococcal Infections/diagnosis/etiology/*prevention & control[MESH]|Staphylococcus aureus/isolation & purification[MESH]|Surgical Wound Infection/diagnosis/etiology/*prevention & control[MESH] |
