Staphylococcus aureus screening and preoperative decolonisation with Mupirocin and Chlorhexidine to reduce the risk of surgical site infections in orthopaedic surgery: a pre-post study.
Mupirocin
/ administration & dosage
Chlorhexidine
/ therapeutic use
Humans
Surgical Wound Infection
/ prevention & control
Retrospective Studies
Staphylococcal Infections
/ prevention & control
Female
Male
Staphylococcus aureus
/ drug effects
Middle Aged
Aged
Orthopedic Procedures
/ adverse effects
Risk Factors
Anti-Bacterial Agents
/ therapeutic use
Preoperative Care
Carrier State
/ drug therapy
Mass Screening
France
Staphylococcus aureus
Chlorhexidine
Decolonisation
Mupirocin
Screening
Surgical site infection
Journal
Antimicrobial resistance and infection control
ISSN: 2047-2994
Titre abrégé: Antimicrob Resist Infect Control
Pays: England
ID NLM: 101585411
Informations de publication
Date de publication:
11 Jul 2024
11 Jul 2024
Historique:
received:
13
03
2024
accepted:
28
06
2024
medline:
12
7
2024
pubmed:
12
7
2024
entrez:
11
7
2024
Statut:
epublish
Résumé
Nasal carriage of Staphylococcus aureus is a risk factor for surgical site infections (SSI) in orthopaedic surgery. The efficacy of decolonisation for S. aureus on reducing the risk of SSI is uncertain in this speciality. The objective was to evaluate the impact of a nasal screening strategy of S. aureus and targeted decolonisation on the risk of S. aureus SSI. A retrospective pre-post and here-elsewhere study was conducted between January 2014 and June 2020 in 2 adult orthopaedic surgical sites (North and South) of a French university hospital. Decolonisation with Mupirocin and Chlorhexidine was conducted in S. aureus carriers starting February 2017 in the South site (intervention group). Scheduled surgical procedures for hip, knee arthroplasties, and osteosyntheses were included and monitored for one year. The rates of S. aureus SSI in the intervention group were compared to a historical control group (South site) and a North control group. The risk factors for S. aureus SSI were analysed by logistic regression. A total of 5,348 surgical procedures was included, 100 SSI of which 30 monomicrobial S. aureus SSI were identified. The preoperative screening result was available for 60% (1,382/2,305) of the intervention group patients. Among these screenings, 25.3% (349/1,382) were positive for S. aureus and the efficacy of the decolonisation was 91.6% (98/107). The rate of S. aureus SSI in the intervention group (0.3%, 7/2,305) was not significantly different from the historical control group (0.5%, 9/1926) but differed significantly from the North control group (1.3%, 14/1,117). After adjustment, the risk factors of S. aureus SSI occurrence were the body mass index (ORa Despite the low number of SSI, nasal screening and targeted decolonisation of S. aureus were associated with a reduction in S. aureus SSI.
Sections du résumé
BACKGROUND
BACKGROUND
Nasal carriage of Staphylococcus aureus is a risk factor for surgical site infections (SSI) in orthopaedic surgery. The efficacy of decolonisation for S. aureus on reducing the risk of SSI is uncertain in this speciality. The objective was to evaluate the impact of a nasal screening strategy of S. aureus and targeted decolonisation on the risk of S. aureus SSI.
METHODS
METHODS
A retrospective pre-post and here-elsewhere study was conducted between January 2014 and June 2020 in 2 adult orthopaedic surgical sites (North and South) of a French university hospital. Decolonisation with Mupirocin and Chlorhexidine was conducted in S. aureus carriers starting February 2017 in the South site (intervention group). Scheduled surgical procedures for hip, knee arthroplasties, and osteosyntheses were included and monitored for one year. The rates of S. aureus SSI in the intervention group were compared to a historical control group (South site) and a North control group. The risk factors for S. aureus SSI were analysed by logistic regression.
RESULTS
RESULTS
A total of 5,348 surgical procedures was included, 100 SSI of which 30 monomicrobial S. aureus SSI were identified. The preoperative screening result was available for 60% (1,382/2,305) of the intervention group patients. Among these screenings, 25.3% (349/1,382) were positive for S. aureus and the efficacy of the decolonisation was 91.6% (98/107). The rate of S. aureus SSI in the intervention group (0.3%, 7/2,305) was not significantly different from the historical control group (0.5%, 9/1926) but differed significantly from the North control group (1.3%, 14/1,117). After adjustment, the risk factors of S. aureus SSI occurrence were the body mass index (ORa
CONCLUSIONS
CONCLUSIONS
Despite the low number of SSI, nasal screening and targeted decolonisation of S. aureus were associated with a reduction in S. aureus SSI.
Identifiants
pubmed: 38992708
doi: 10.1186/s13756-024-01432-2
pii: 10.1186/s13756-024-01432-2
doi:
Substances chimiques
Mupirocin
D0GX863OA5
Chlorhexidine
R4KO0DY52L
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
75Informations de copyright
© 2024. The Author(s).
Références
Korol E, Johnston K, Waser N, Sifakis F, Jafri HS, Lo M, et al. A Systematic Review of Risk Factors Associated with Surgical Site Infections among Surgical Patients. Khan AU, editor. PLoS ONE. 2013;8(12):e83743.
Surveillance des infections du site opératoire dans les établissements de santé français. Mission Spicmi, septembre 2020, données 2018 du réseau ISO Raisin. Santé publique France, 2020. https://www.santepubliquefrance.fr/content/download/373269/3152059?version=1 . Accessed 6 Feb 2024.
Levy PY, Ollivier M, Drancourt M, Raoult D, Argenson JN. Relation between nasal carriage of Staphylococcus aureus and surgical site infection in orthopedic surgery: The role of nasal contamination. A systematic literature review and meta-analysis. Orthop Traumatol Surg Res. 2013;99:645–51.
doi: 10.1016/j.otsr.2013.03.030
pubmed: 23992764
Nakamura M, Shimakawa T, Nakano S, Chikawa T, Yoshioka S, Kashima M, et al. Screening for nasal carriage of Staphylococcus aureus among patients scheduled to undergo orthopedic surgery: Incidence of surgical site infection by nasal carriage. J Orthop Sci. 2017;22:778–82.
doi: 10.1016/j.jos.2017.03.005
pubmed: 28390756
Global guidelines for the prevention of surgical site infection [Internet]. 2nd ed. World Health Organization, 2018. https://apps.who.int/iris/handle/10665/277399 . Accessed 6 Feb 2024.
Sousa RJG, Barreira PMB, Leite PTS, Santos ACM, Ramos MHSS, Oliveira AF. Preoperative Staphylococcus aureus Screening/Decolonization Protocol Before Total Joint Arthroplasty—Results of a Small Prospective Randomized Trial. J Arthroplasty. 2016;31:234–9.
doi: 10.1016/j.arth.2015.08.003
pubmed: 26362785
Rohrer F, Nötzli H, Risch L, Bodmer T, Cottagnoud P, Hermann T, et al. Does Preoperative Decolonization Reduce Surgical Site Infections in Elective Orthopaedic Surgery? A Prospective Randomized Controlled Trial. Clin Orthop. 2020;478:1790–800.
doi: 10.1097/CORR.0000000000001152
pubmed: 32058435
pmcid: 7371089
Gestion préopératoire du risque infectieux - mise à jour de la conférence de consensus. Société Française d’Hygiène Hospitalière, 2013. https://sf2h.net/publications/gestion-preoperatoire-risque-infectieux-mise-a-jour-de-conference-de-consensus . Accessed 6 Feb 2024.
Forget V, Fauconnier J, Boisset S, Pavese P, Vermorel C, Bosson JL, et al. Risk factors for Staphylococcus aureus surgical site infections after orthopaedic and trauma surgery in a French university hospital. Int J Hyg Environ Health. 2020;229:113585.
doi: 10.1016/j.ijheh.2020.113585
pubmed: 32781428
Réseau ISO-Raisin, Protocole national de surveillance des Infections du Site Opératoire (Surveillance des interventions prioritaires), Année 2018. Réseau d'Alerte, d'Investigation et de Surveillance des Infections Nosocomiales, 2018. https://www.cpias-ile-de-france.fr/surveillance/iso/2018/iso_raisin_protocole_2018_surv_prioritaire.pdf . Accessed 6 Feb 2024.
Martin C, Auboyer C, Dupont H, Gauzit, Kitzis M, et al. Antibioprophylaxis in surgery and interventional medicine (adult patients). Anaesth Crit Care Pain Med. 2019;38:549–62 Update 2017.
doi: 10.1016/j.accpm.2019.02.017
pubmed: 30836191
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32.
doi: 10.1016/j.ajic.2008.03.002
pubmed: 18538699
Charlson ME, Pompei P, Ales KL. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
doi: 10.1016/0021-9681(87)90171-8
pubmed: 3558716
Altemeier WA, Culbertson WR, Hummel RP. Surgical Considerations of Endogenous Infections — Sources, Types, and Methods of Control. Surg Clin North Am. 1968;48:227–40.
doi: 10.1016/S0039-6109(16)38448-1
pubmed: 5640439
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.
doi: 10.1016/j.jclinepi.2007.11.008
Rohrer F, Nötzli H, Risch L, Bodmer T, Cottagnoud P, Hermann T, et al. Does Preoperative Decolonization Reduce Surgical Site Infections in Elective Orthopaedic Surgery? A Prospective Randomized Controlled Trial. Clin Orthop. 2020;478:1790–800.
doi: 10.1097/CORR.0000000000001152
pubmed: 32058435
pmcid: 7371089
Kalmeijer MD, Coertjens H, van Nieuwland-Bollen PM, Bogaers-Hofman D, de Baere GAJ, Stuurman A, et al. Surgical Site Infections in Orthopedic Surgery: The Effect of Mupirocin Nasal Ointment in a Double-Blind, Randomized Placebo-Controlled Study. Clin Infect Dis. 2002;35:353–8.
doi: 10.1086/341025
pubmed: 12145715
Kim DH, Spencer M, Davidson SM, Li L, Shaw JD, Gulczynski D, et al. Institutional Prescreening for Detection and Eradication of Methicillin-Resistant Staphylococcus aureus in Patients Undergoing Elective Orthopaedic Surgery. J Bone Jt Surg. 2010;92:1820–6.
doi: 10.2106/JBJS.I.01050
Sousa RJG, Barreira PMB, Leite PTS, Santos ACM, Ramos MHSS, Oliveira AF. Preoperative Staphylococcus aureus Screening/Decolonization Protocol Before Total Joint Arthroplasty—Results of a Small Prospective Randomized Trial. J Arthroplasty. 2016;31:234–9.
doi: 10.1016/j.arth.2015.08.003
pubmed: 26362785
Bode LGM, Bogaers D, Troelstra A, van Belkum A. Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus. N Engl J Med. 2010;362:9–17.
doi: 10.1056/NEJMoa0808939
pubmed: 20054045
Schweizer ML, Chiang HY, Septimus E, Moody J, Braun B, Hafner J, et al. Association of a Bundled Intervention With Surgical Site Infections Among Patients Undergoing Cardiac, Hip, or Knee Surgery. JAMA. 2015;313:2162.
doi: 10.1001/jama.2015.5387
pubmed: 26034956
Hofmann KJ, Hayden BL, Kong Q, Pevear ME, Cassidy C, Smith EL. Triple prophylaxis for the prevention of surgical site infections in total joint arthroplasty. Curr Orthop Pract. 2017;28:66–9.
doi: 10.1097/BCO.0000000000000454
Hacek DM, Robb WJ, Paule SM, Kudrna JC, Stamos VP, Peterson LR. Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection. Clin Orthop. 2008;466:1349–55.
doi: 10.1007/s11999-008-0210-y
pubmed: 18347889
pmcid: 2384050
Hadley S, Immerman I, Hutzler L, Slover J, Bosco J. Staphylococcus aureus Decolonization Protocol Decreases Surgical Site Infections for Total Joint Replacement. Arthritis. 2010;2010:1–4.
doi: 10.1155/2010/924518
Jeans E, Holleyman R, Tate D, Reed M, Malviya A. Methicillin sensitive Staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty. J Infect. 2018;77:405–9.
doi: 10.1016/j.jinf.2018.05.012
pubmed: 29932962
Sporer SM, Rogers T, Abella L. Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Screening and Decolonization to Reduce Surgical Site Infection in Elective Total Joint Arthroplasty. J Arthroplasty. 2016;31:144–7.
doi: 10.1016/j.arth.2016.05.019
pubmed: 27387479
Pelfort X, Romero A, Brugués M, García A, Gil S, Marrón A. Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty. Acta Orthop Traumatol Turc. 2019;53:426–31.
doi: 10.1016/j.aott.2019.08.014
pubmed: 31537434
pmcid: 6938997
van der Sluis AJG, Hoogenboom-Verdegaal AM, Edixhoven PJ, van Rooijen NHS. Prophylactic mupirocin could reduce orthopedic wound infections: 1,044 patients treated with mupirocin compared with 1,260 historical controls. Acta Orthop Scand. 1998;69:412–4.
doi: 10.3109/17453679808999058
Zhu X, Sun X, Zeng Y, Feng W, Li J, Zeng J, et al. Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis. J Orthop Surg. 2020;15:60.
doi: 10.1186/s13018-020-01601-0
Ribau AI, Collins JE, Chen AF, Sousa RJ. Is Preoperative Staphylococcus aureus Screening and Decolonization Effective at Reducing Surgical Site Infection in Patients Undergoing Orthopedic Surgery? A Systematic Review and Meta-Analysis With a Special Focus on Elective Total Joint Arthroplasty. J Arthroplasty. 2021;36:752-766.e6.
doi: 10.1016/j.arth.2020.08.014
pubmed: 32950342
Prattingerová J, Sarvikivi E, Huotari K, Ollgren J, Lyytikäinen O. Surgical site infections following hip and knee arthroplastic surgery: Trends and risk factors of Staphylococcus aureus infections. Infect Control Hosp Epidemiol. 2019;40:211–3.
doi: 10.1017/ice.2018.312
pubmed: 30522540
Crowe B, Payne A, Evangelista PJ, Stachel A, Phillips MS, Slover JD, et al. Risk Factors for Infection Following Total Knee Arthroplasty: A Series of 3836 Cases from One Institution. J Arthroplasty. 2015;30:2275–8.
doi: 10.1016/j.arth.2015.06.058
pubmed: 26187387
Berthelot P, Grattard F, Cazorla C, Passot JP, Fayard JP, Meley R, et al. Is nasal carriage of Staphylococcus aureus the main acquisition pathway for surgical-site infection in orthopaedic surgery? Eur J Clin Microbiol Infect Dis. 2010;29:373–82.
doi: 10.1007/s10096-009-0867-5
pubmed: 20108109
Kline SE, Neaton JD, Lynfield R, Ferrieri P, Kulasingam S, Dittes K, et al. Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization. Infect Control Hosp Epidemiol. 2018;39:1049–57.
doi: 10.1017/ice.2018.151
pubmed: 30037355
Stambough JB, Nam D, Warren DK, Keeney JA, Clohisy JC, Barrack RL, et al. Decreased Hospital Costs and Surgical Site Infection Incidence With a Universal Decolonization Protocol in Primary Total Joint Arthroplasty. J Arthroplasty. 2017;32:728-734.e1.
doi: 10.1016/j.arth.2016.09.041
pubmed: 27823845
Dadashi M, Hajikhani B, Darban-Sarokhalil D, van Belkum A, Goudarzi M. Mupirocin resistance in Staphylococcus aureus: A systematic review and meta-analysis. J Glob Antimicrob Resist. 2020;20:238–47.
doi: 10.1016/j.jgar.2019.07.032
pubmed: 31442624
Hetem DJ, Bonten MJM. Clinical relevance of mupirocin resistance in Staphylococcus aureus. J Hosp Infect. 2013;85:249–56.
doi: 10.1016/j.jhin.2013.09.006
pubmed: 24144552
Walker ES, Vasquez JE, Dula R, Bullock H, Sarubbi FA. Mupirocin-Resistant, Methicillin-Resistant Staphylococcus aureus : Does Mupirocin Remain Effective? Infect Control Hosp Epidemiol. 2003;24:342–6.
doi: 10.1086/502218
pubmed: 12785407
Madden GR, Sifri CD. Antimicrobial Resistance to Agents Used for Staphylococcus aureus Decolonization: Is There a Reason for Concern? Curr Infect Dis Rep. 2018;20:26.
doi: 10.1007/s11908-018-0630-0
pubmed: 29882094
pmcid: 7015675
Suwantarat N, Carroll KC, Tekle T, Ross T, Maragakis LL, Cosgrove SE, et al. High Prevalence of Reduced Chlorhexidine Susceptibility in Organisms Causing Central Line-Associated Bloodstream Infections. Infect Control Hosp Epidemiol. 2014;35:1183–6.
doi: 10.1086/677628
pubmed: 25111928
Hayden MK, Lolans K, Haffenreffer K, Avery TR, Kleinman K, Li H, et al. Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial. J Clin Microbiol. 2016;54:2735–42.
doi: 10.1128/JCM.01444-16
pubmed: 27558180
pmcid: 5078551
Lepelletier D, Maillard JY, Pozzetto B, Simon A. Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and Staphylococcus aureus Decolonization. Antimicrob Agents Chemother. 2020;64:e00682-20.
doi: 10.1128/AAC.00682-20
pubmed: 32571829
pmcid: 7449185
Mody L, Kauffman CA, McNeil SA, Galecki AT, Bradley SF. Mupirocin-Based Decolonization of Staphylococcus aureus Carriers in Residents of 2 Long-Term Care Facilities: A Randomized, Double-Blind. Placebo-Controlled Trial Clin Infect Dis. 2003;37:1467–74.
doi: 10.1086/379325
pubmed: 14614669