Staphylococcus aureus screening and decolonization in orthopaedic surgery and reduction of surgical site infections

Abstract

Background: Staphylococcus aureus is the most common organism responsible for orthopaedic surgical site infections (SSIs). Patients who are carriers for methicillin-sensitive S. aureus or methicillin-resistant S. aureus (MRSA) have a higher likelihood of having invasive S. aureus infections. Although some have advocated screening for S. aureus and decolonizing it is unclear whether these efforts reduce SSIs.

Questions/purposes: The purposes of this study were to determine (1) whether S. aureus screening and decolonization reduce SSIs in orthopaedic patients and (2) if implementing this protocol is cost-effective.

Methods: Studies for this systematic review were identified by searching PubMed, which includes MEDLINE (1946-present), EMBASE.com (1974-present), and the Cochrane Library's (John Wiley & Sons) Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTAD), and the NHS Economic Evaluation Database (NHSEED). Comprehensive literature searches were developed using EMTREE, MeSH, and keywords for each of the search concepts of decolonization, MRSA, and orthopedics/orthopedic surgery. Studies published before 1968 were excluded. We analyzed 19 studies examining the ability of the decolonization protocol to reduce SSIs and 10 studies detailing the cost-effectiveness of S. aureus screening and decolonization.

Results: All 19 studies showed a reduction in SSIs or wound complications by instituting a S. aureus screening and decolonization protocol in elective orthopaedic (total joints, spine, and sports) and trauma patients. The S. aureus screening and decolonization protocol also saved costs in orthopaedic patients when comparing the costs of screening and decolonization with the reduction of SSIs.

Conclusions: Preoperative screening and decolonization of S. aureus in orthopaedic patients is a cost-effective means to reduce SSIs.

Level of evidence: Level IV, systematic review of Level I-IV studies. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

A PRISMA flow diagram shows the selection criteria for S. aureus screening and decolonization studies in orthopaedic surgery.

Fig. 2A–C

The percentages are shown for (A) total SSI reduction, (B) S. aureus SSI reduction, and (C) MRSA SSI reduction after instituting a S. aureus decolonization protocol in orthopaedics.

Fig. 2A–C

The percentages are shown for (A) total SSI reduction, (B) S. aureus SSI reduction, and (C) MRSA SSI reduction after instituting a S. aureus decolonization protocol in orthopaedics.