Preoperative Staphylococcus aureus screening and eradication.

Autor:	Scholten R; Department of Orthopedic Surgery, Rijnstate Ziekenhuis, Arnhem, the Netherlands., Hannink G; Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands., Willemsen K; Department of Infection Control, Rijnstate Ziekenhuis, Arnhem, the Netherlands., Mascini EM; Laboratory of Medical Microbiology and Immunology, Rijnstate Ziekenhuis, Arnhem, the Netherlands., Somford MP; Department of Orthopedic Surgery, Rijnstate Ziekenhuis, Arnhem, the Netherlands., Schreurs BW; Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands., van Susante JLC; Department of Orthopedic Surgery, Rijnstate Ziekenhuis, Arnhem, the Netherlands.
Jazyk:	angličtina
Zdroj:	The bone & joint journal [Bone Joint J] 2020 Oct; Vol. 102-B (10), pp. 1341-1348.
DOI:	10.1302/0301-620X.102B10.BJJ-2020-0038.R1
Abstrakt:	Aims: Preoperative nasal Staphylococcus aureus screening and eradication reduces surgical site infections (SSIs) but its impact on reducing early prosthetic joint infection (PJI) remains controversial. This study aims to assess the effect of preoperative nasal S. aureus screening and eradication on the incidence of early PJI in general and S. aureus- induced early PJI. Methods: All primary total hip arthroplasties (THA) and total knee arthroplasties (TKA) performed from January 2006 to April 2018 were retrospectively reviewed for the incidence of early PJI. Demographic parameters, risk factors for PJI (American Society of Anaesthesiologists classification, body mass index, smoking status, and diabetes mellitus) and implant types were collected. A preoperative screening and eradication protocol for nasal colonization of S. aureus was introduced in October 2010. The incidence of early PJI was compared before and after the implementation of the protocol. Missing data were imputed via multiple imputation by chained equations. Inverse probability weighting was used to account for differences between patients in both groups. Weighted univariate logistic regression was used to evaluate the incidence of early PJI for both groups. Results: In total, 10,486 THAs and TKAs were performed in the research period. After exclusion, a cohort of 5,499 screened cases and 3,563 non-screened cases were available for analysis. Overall, no significant reduction in early PJI was found in the screened group (odds ratio (OR) 0.78, 95% confidence interval (CI) 0.55 to 1.11; p = 0.173). However, the incidence of S. aureus -induced PJI was significantly reduced (OR 0.58, 95% CI 0.36 to 0.92; p = 0.027) in the screened group. Conclusion: A preoperative nasal S. aureus screening and eradication protocol did not significantly reduce the overall incidence of early PJI after THA or TKA. However, a decreased incidence of S. aureus -induced early PJI was established. These findings can help to establish better consensus around the value of these screening protocols. Cite this article: Bone Joint J 2020;102-B(10):1341-1348.
Databáze:	MEDLINE
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