Evaluation of Staphylococcus aureus eradication therapy in orthopaedic surgery

Jerry Tsang (Lead Author), Martin McHugh, Daniel Guerendiain, Peter Gwynne, Stephanie Lewis, Ian F Laurenson, Kate Templeton, Hamish Simpson, Tim Walsh

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Purpose. Despite WHO recommendations there is currently no national screening and eradication policy for the detection of methicillin-sensitive Staphylococcus aureus (MSSA) in the UK prior to elective orthopaedic surgery. This study aimed to evaluate the effectiveness of current standard methicillin-resistant S. aureus (MRSA) eradication therapies in the context of S. aureus (both MRSA and MSSA) decolonisation in an elective orthopaedic population. Methodology. A total of 100 patients awaiting joint replacement surgery who were positive for S. aureus on PCR nasal screening underwent the current standard MRSA pre-operative decolonisation regimen for five days. Prior to commencement of the eradication therapy swabs of the anterior nares, throat, and perineum were taken for culture. Further culture swabs were taken at 48-96 hours following treatment, at hospital admission for surgery, and at hospital discharge. Following completion of treatment patients were asked to provide feedback on their experience using Likert rating scales. The primary outcome of this study was S. aureus clearance 48-96 hours following eradication treatment. Results/Key Findings. Clearance of S. aureus 48-96 hours following treatment was 94% anterior nares, 66% throat, and 88% groin. Mean completion with nasal mupirocin was 98%. There was no statistically significant recolonisation effect between the end of the eradication treatment period and the day of surgery (p>0.05) at a median time of 10 days. Conclusion. Current MRSA decolonisation regimens are well-tolerated and effective for MSSA decolonisation for the anterior nares and groin. The decolonisation effect is preserved for at least 10 days following treatment.
Original languageEnglish
JournalJournal of Medical Microbiology
Early online date19 Apr 2018
Publication statusE-pub ahead of print - 19 Apr 2018


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