Hacek Donna M, Robb William J, Paule Suzanne M, Kudrna James C, Stamos Van Paul, Peterson Lance R
Evanston Northwestern Healthcare, Evanston, IL, USA.
Clin Orthop Relat Res. 2008 Jun;466(6):1349-55. doi: 10.1007/s11999-008-0210-y. Epub 2008 Mar 18.
Surgical site infections (SSIs) with Staphylococcus aureus are a recognized adverse event of hip and knee replacements. We evaluated the impact of a program to detect S. aureus nasal carriers before surgery with preoperative decolonization (using mupirocin twice daily for 5 days prior to surgery) of carriers. Nasal swab samples were obtained from patients prior to surgery from 8/1/2003 through 2/28/2005. Samples were tested using real-time PCR technology to detect S. aureus. The group that developed S. aureus SSI was compared to a combined concurrent and historical control for one year following the operation. S. aureus caused 71% of SSIs in the combined control groups. Of the 1495 surgical candidates evaluated, 912 (61.0%) were screened for S. aureus; 223 of those screened (24.5%) were positive and then decolonized with mupirocin. Among the 223 positive and decolonized patients, three (1.3%) developed a SSI. Among the 689 screen-negative patients, four (0.6%) developed SSIs for an overall rate of 0.77%. Among the 583 control patients who were not screened or decolonized, 10 (1.7%) developed S. aureus SSIs. SSIs from other organisms were 0.44% and 0.69%, respectively.
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
金黄色葡萄球菌引起的手术部位感染（SSIs）是髋关节和膝关节置换手术公认的不良事件。我们评估了一项术前检测金黄色葡萄球菌鼻腔携带者并对携带者进行术前去定植（术前5天每天两次使用莫匹罗星）的计划的影响。在2003年8月1日至2005年2月28日期间，在患者手术前采集鼻拭子样本。使用实时PCR技术检测样本中的金黄色葡萄球菌。将发生金黄色葡萄球菌手术部位感染的组与术后一年的同期和历史对照组合进行比较。金黄色葡萄球菌在联合对照组中导致了71%的手术部位感染。在1495名接受评估的手术候选者中，912名（61.0%）接受了金黄色葡萄球菌筛查；其中223名筛查呈阳性（24.5%），随后用莫匹罗星进行去定植。在223名阳性且已去定植的患者中，有3名（1.3%）发生了手术部位感染。在689名筛查阴性的患者中，有4名（0.6%）发生了手术部位感染，总体发生率为0.77%。在583名未进行筛查或去定植的对照患者中，有10名（1.7%）发生了金黄色葡萄球菌手术部位感染。来自其他微生物的手术部位感染率分别为0.44%和0.69%。
III级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
