Prevalence of Nasal Carriage of Methicillin-Sensitive and Methicillin-Resistant Staphylococcus aureus in Candidates for Total Hip or Knee Arthroplasty

Abstract

Introduction Surgical-site infections in joint replacement surgery are an important source of morbidity and mortality that entail high economic and social burden both for the patient and their environment. Preoperative colonization by Staphylococcus aureus has been recognized as an important risk factor for the development of surgical-site infection.

The aim of the present study is to determine the prevalence of nasal colonization by S. aureus, both methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) in patients who are candidates for total replacement of the hip or knee joints.

Materials and methods A retrospective observational study of a cohort of 646 patients with an indication to undergo total hip arthroplasty (THA) or total knee arthroplasty (TKA) due to severe osteoarthritis was performed in a Public Hospital in Chile. The patients were submitted to a preoperative screening for S. aureus carriage, and the culture samples were obtained by swabbing both nostrils. The laboratory data was collected and presented as a percentage of carriage.

Results We consecutively examined 303 THA and 343 TKA patients. A total of 483 of the 646 patients (74.7%) underwent a preoperative study of nasal carriage. We identified 123 (25.4%) S. aureus carriers, and only found 2 (0.41%) cases corresponding to MRSA.

Conclusion We found a prevalence of nasal carriage of S. aureus of 25.4%, a rate similar to that reported in other series. The prevalence of MRSA (0.41%), however, was lower than that reported in the international literature (0.6–6%). Given the high prevalence of carriage described in our work and according to recently published data, it would be worthwhile to carry out universal decolonization protocols, without the need for preoperative screening.

Keywords

hip replacement - knee replacement - preoperative screening - Staphylococcus aureus - decolonization

Financial Support

The authors declare that they have not received any external financial support to conduct the present study.

Publication History

Received: 14 September 2021

Accepted: 30 March 2022

Article published online:
28 December 2022

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