Estimating effectiveness of nasal decolonization in prevention of peri-prosthetic joint infection in nasal carriers of Staphylococcus aureus undergoing arthroplasty in a tertiary care institution

Abstract

Introduction: Peri-prosthetic joint infection (PJI) is one of the most challenging complications after total joint arthroplasty (TJA) surgeries. This study aims to (i) compare overall PJI rates with and without pre-operative nasal screening and decolonization for Staphylococcus aureus; (ii) estimate the difference in SSI rates between carriers and non-carriers undergoing TJA; and (iii) determine the efficacy of decolonization in reducing PJI rate in nasal carriers. Methods: A total of 760 patients were included in the study; with 399 patients in the study group, who underwent pre-operative screening and decolonization for nasal colonization with S. aureus; and 361 patients in the control group, who did not undergo pre-operative screening for nasal colonization. Patients were followed for 90 days post-surgery, and PJI rates were recorded following the Centers for Disease Control SSI criteria. Results: Twenty-one (5.26%) out of 399 patients in the study group developed PJI as opposed to 38 (10.53%) out of 361 patients in the control group. PJI rate due to either MSSA or MRSA was 2.5% in the study group (10/399) as opposed to 7.75% in the control group (28/361), with “P value” of 0.002 (<0.05). Discussion: The overall SSI incidence was reduced by 51% after implementing the decolonization protocol. Regarding specific S. aureus SSI, 7.5% of the SSIs in the control group were caused by S. aureus, while only 2.5% were caused by this microorganism after implementing the screening and decolonization protocol. Conclusion: Implementing a screening and decolonization protocol for S. aureus before TJA can lead to a significant reduction in S. aureus surgical site infections.