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. 2018 Jan;7(1):79-84.
doi: 10.1302/2046-3758.71.BJR-2017-0175.R1.

Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed

S T J Tsang  1 , M P McHugh  2 , D Guerendiain  2 , P J Gwynne  3 , J Boyd  4 , A H R W Simpson  5 , T S Walsh  6 , I F Laurenson  2 , K E Templeton  2
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Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed

S T J Tsang et al. Bone Joint Res. 2018 Jan.

Abstract

Objectives: Nasal carriers of Staphylococcus (S.) aureus (MRSA and MSSA) have an increased risk for healthcare-associated infections. There are currently limited national screening policies for the detection of S. aureus despite the World Health Organization's recommendations. This study aimed to evaluate the diagnostic performance of molecular and culture techniques in S. aureus screening, determine the cause of any discrepancy between the diagnostic techniques, and model the potential effect of different diagnostic techniques on S. aureus detection in orthopaedic patients.

Methods: Paired nasal swabs for polymerase chain reaction (PCR) assay and culture of S. aureus were collected from a study population of 273 orthopaedic outpatients due to undergo joint arthroplasty surgery.

Results: The prevalence of MSSA nasal colonization was found to be between 22.4% to 35.6%. The current standard direct culturing methods for detecting S. aureus significantly underestimated the prevalence (p = 0.005), failing to identify its presence in approximately one-third of patients undergoing joint arthroplasty surgery.

Conclusion: Modelling these results to national surveillance data, it was estimated that approximately 5000 to 8000 S. aureus surgical site infections could be prevented, and approximately $140 million to $950 million (approximately £110 million to £760 million) saved in treatment costs annually in the United States and United Kingdom combined, by using alternative diagnostic methods to direct culture in preoperative S. aureus screening and eradication programmes.Cite this article: S. T. J. Tsang, M. P. McHugh, D. Guerendiain, P. J. Gwynne, J. Boyd, A. H. R. W. Simpson, T. S. Walsh, I. F. Laurenson, K. E. Templeton. Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed. Bone Joint Res 2018;7:79-84. DOI: 10.1302/2046-3758.71.BJR-2017-0175.R1.

Keywords: Periprosthetic joint infection; Staphylococcus aureus; Surgical site infection.

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Conflict of interest statement

Conflicts of Interest Statement: The authors declare that there are no conflicts of interest.

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References

    1. No authors listed. Public Health England. Surgical site infection surveillance service (SSISS). https://www.gov.uk/guidance/surgical-site-infection-surveillance-service... (date last accessed 07 December 2017).
    1. No authors listed. Centers for Disease Control and Prevention. Surgical Site Infection (SSI). https://www.cdc.gov/hai/ssi/ssi.html (date last accessed 07 December 2017).
    1. Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183-189. - PubMed
    1. Huotari K, Lyytikäinen O, Ollgren J, et al. Hospital Infection Surveillance Team. Disease burden of prosthetic joint infections after hip and knee joint replacement in Finland during 1999-2004: capture-recapture estimation. J Hosp Infect 2010;75:205-208. - PubMed
    1. Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010;468:52-56. - PMC - PubMed