Nose/Knee Infection Connection!
Ideally, says a new study, patients should be preoperatively screened for nasal bacteria colonization.
Researchers from the Icahn School of Medicine at Mount Sinai examined data from 716 patients who underwent nasal screening prior to joint replacement. Their work, “Risk Factors for Staphylococcus Aureus Nasal Colonization in Joint Replacement Patients,” appears in the December 29, 2017 edition of The Journal of Arthroplasty.
Calin S. Moucha, M.D., chief of Adult Reconstruction and Joint Replacement Surgery at The Mount Sinai Medical Center in New York and study co-author told OTW, “I treat a high number of periprosthetic joint infection cases and while caring for these patients is very gratifying, treatment is not easy and certainly not risk free.”
“Preventing infections should still be a top priority and optimizing patients preop by decolonization has been shown to be effective. Not every hospital or practice has the ability to screen and decolonize every patient, so we tried to identify patients at risk of staph colonization so that at least these high-risk patients can be screened and decolonized.”
The authors wrote, “This study is a retrospective review of 716 patients undergoing hip or knee replacement beginning in 2011. All patients were screened preoperatively for nasal colonization.”
Dr. Moucha commented to OTW, “We found that 17.5% of patients undergoing primary hip or knee replacement surgery screened positive for S. aureus. Diabetes, renal insufficiency, and immunosuppression are risk factors for such colonization. Given that these comorbidities are already known independent risk factors for periprosthetic joint infection, these patients should be particularly screened and when necessary, decolonized.”
“If you cannot screen and decolonize every total joint replacement patient at least focus resources on these high-risk patients. Patients with diabetes, renal disease, and immunosuppression are at risk! Screen, decolonize, and adjust antibiotic prophylaxis according to your patient’s skin flora. In addition, communicate at least yearly with your hospital’s epidemiologist/infection control teams and review your hospital’s antibiogram.”
