Illinois physicians discover link to postop infections

Researchers at the Illinois Bone and Joint Institute have discovered a link between nasal Staphylococcus aureus bacteria and postsurgical infections.

The study, published in the June issue of Clinical Orthopaedics and Related Research, was conducted by Lance Peterson, MD, an infection disease specialist, and Illinois Bone and Joint Institute (IBJI) surgeons James Kudrna, MD, and William Robb, MD.

The study, which began in 2003, involved a simple preoperative nasal swab test for Staphylococcus aureus. S. aureus is responsible for the majority of postsurgical infections in total knee and hip arthroplasty surgeries.

"About 25% of the general population has S. aureus in their nasal passages and don't have symptoms," Robb said in a press release from IBJI. "One quality of Staph bacteria is that it spreads in fresh wounds. A patient with S. aureus in the nasal passages can unknowingly transfer the bacteria simply by touching his nose and then the surgical area."

In the pilot program, nearly 1,500 patients received the preop nasal swabs. Patients who tested positively for Staph were then treated with an ointment for 5 days prior to surgery. This presurgical topical antibiotic therapy was the key to driving down postsurgical infections, he said in the press release.

At the conclusion of the pilot program in February 2005, Evanston Northwestern Hospital (ENH) instituted preop nasal screening as a standard protocol for all major surgeries.

What made the treatment more practical was an emerging technology called Polymerase Chain Reaction testing, which increased the speed at which the Staph bacteria were identified, Robb said in the press release.

David Shapiro, MD, an IBJI spine surgeon, noted the encouraging preliminary results of the study. Shapiro, also affiliated with ENH, decided to study spine patients to determine if the methodology had the same benefit for those individuals.

Shapiro; his brother Gary Shapiro, MD, an IBJI spine surgeon; and Peterson co-authored an orthopedic spine surgery study comparing the postsurgical infection rates of nearly 1,400 patients. About half of the patients were screened preoperatively. The screened group had a surgical infection rate of 0.7% compared to 1.5% for the non-screened group.

The results of the spine study were presented in October to attendees at the North American Spine Society meeting.

David Shapiro is continuing his research in a second study, where he is looking at more specific issues affecting infection rates. The results of the second study will be available in 2009.

For more information:

Illinois Bone and Joint Institute 8930 Waukegan Road Suite 200 Morton Grove, IL 60053; 847-324-3975, e-mail: tbone@ibji.com; www.ibji.com.

Reference:

Brockenbrough G. Preop nasal screening for Staph shows significantly lower postop infection rates. Orthopedics Today. 28;2:69. http://www.orthosupersite.com/view.asp?rID=24529.