This article is more than 5 years old. Information may no longer be current.

Preoperative treatment to prevent MRSA, MSSA in TJA can lower infection rates

Ointments, baths and antibiotic combination appeared to help block surgical site infections.

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

SAN DIEGO — A unique regimen for attacking methicillin-susceptible Staphylococcus aureus and methicillin-resistant Staphylococcus aureus preoperatively in total joint arthroplasty patients can significantly reduce surgical site infection incidence, a new study shows.

The regimen can also save money, according to Nalini Rao, MD, who presented her study at the Musculoskeletal Infection Society's 17th Annual Open Scientific Meeting, held here.

Over a 12-month study period, 1,906 patients underwent total joint arthroplasty (TJA), with 636 of those patients screened for methicillin-susceptible Staphylococcus aureus (MSSA) and for methicillin-resistant Staphylococcus aureus (MRSA), Rao said. Among this 636-patient group, 147 patients (23%) tested positive for MSSA and 17 patients (3%) tested positive for MRSA, for a total of 164 patients (26%).

The preoperative treatments for the 636-patient group included mupirocin nasal ointment for 5 days, a daily, chlorhexidine bath for 5 days, and systematic perioperative antibiotic prophylaxis either 30 or 60 minutes before surgery, depending on the bacteria identified and the specific antibiotic warranted as a result.

"We used nasal swabs 2 weeks before surgery" to identify patients with the bacteria, Rao said during her presentation. None of these patients developed postoperative MSSA/MRSA surgical site infection (SSI) in follow-up out to 1 year.

"I want to emphasize that only the patients who tested positive were treated," said Rao, a clinical professor of medicine an orthopedics, medical director of infection and control, and chief of infectious disease at the University of Pittsburgh Medical Center.

"In contrast, 12 out of 1,330 patients who did not participate in the study developed postoperative MSSA/MRSA SSIs," Rao wrote in her abstract. "Assuming that 25% of 1,330 (345 patients) would have been positive for MSSA/MRSA, [that] accounts for an infection rate of 3.5% (12 of 345; P=.016)."

By preventing the infections in the group that was tested and treated preoperatively, savings to the health care system totaled $270,000, Rao said. The untested group, by contrast, typically would have to spend an estimated $305,000 on extra treatments, she added.

For more information:

• Rao N, Canella B, Hardic F, et al. Preoperative eradication of Staphylococcus aureus prevents surgical site infections in patients undergoing total joint arthroplasty. Presented at the Musculoskeletal Infection Society 17th Annual Open Scientific Meeting. Aug. 10-11, 2007. San Diego.