MRSA-colonized patients found at risk for PJI, despite decolonization prior to TJA

ORLANDO, Fla. — Despite undergoing MRSA decolonization prior to total joint arthroplasty, high risk patients were still at risk for developing periprosthetic joint infection, according to results presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

“In this high risk group of patients, we found that 9% of MRSA colonized patients ended up developing a periprosthetic joint infection, despite undergoing a decolonization strategy. Therefore, decolonizing in MRSA is not 100% effective,” Michael B. Cross, MD, said in his presentation.

In a retrospective review of 1,879 high risk patients who underwent MRSA screening prior to total hip or total knee replacement, Cross and colleagues found 141 patients screened positive for MRSA.

“Out of these 141 positive cultures, we had 13 patients who ended up developing a postoperative periprosthetic joint infection,” Cross said.

He added six of the 13 patients (4%) developed a MRSA infection. The researchers also found staphylococcus epidermis in three patients, methicillin-sensitive Staphylococcus aureus in two patients, enterococcus faecalis in one patient and streptococcus viridans in one patient.

Univariate analysis showed that despite having patients undergo a standard decolonization regimen, preoperative colonization with MRSA was a significant risk factor for developing a periprosthetic joint infection.

“However, we did not find that MRSA-colonized patients were necessarily at a higher risk of developing an actual MRSA infection compared to patients who did not screen positive for MRSA,” Cross said. – by Casey Tingle

Reference:

Kao YYJ, et al. Paper #228. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 1-5, 2016; Orlando, Fla.