Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15206, USA.
Clin Orthop Relat Res. 2013 Jul;471(7):2383-99. doi: 10.1007/s11999-013-2875-0. Epub 2013 Mar 6.
Staphylococcus aureus is the most common organism responsible for orthopaedic surgical site infections (SSIs). Patients who are carriers for methicillin-sensitive S. aureus or methicillin-resistant S. aureus (MRSA) have a higher likelihood of having invasive S. aureus infections. Although some have advocated screening for S. aureus and decolonizing it is unclear whether these efforts reduce SSIs.
QUESTIONS/PURPOSES: The purposes of this study were to determine (1) whether S. aureus screening and decolonization reduce SSIs in orthopaedic patients and (2) if implementing this protocol is cost-effective.
Studies for this systematic review were identified by searching PubMed, which includes MEDLINE (1946-present), EMBASE.com (1974-present), and the Cochrane Library's (John Wiley & Sons) Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTAD), and the NHS Economic Evaluation Database (NHSEED). Comprehensive literature searches were developed using EMTREE, MeSH, and keywords for each of the search concepts of decolonization, MRSA, and orthopedics/orthopedic surgery. Studies published before 1968 were excluded. We analyzed 19 studies examining the ability of the decolonization protocol to reduce SSIs and 10 studies detailing the cost-effectiveness of S. aureus screening and decolonization.
All 19 studies showed a reduction in SSIs or wound complications by instituting a S. aureus screening and decolonization protocol in elective orthopaedic (total joints, spine, and sports) and trauma patients. The S. aureus screening and decolonization protocol also saved costs in orthopaedic patients when comparing the costs of screening and decolonization with the reduction of SSIs.
Preoperative screening and decolonization of S. aureus in orthopaedic patients is a cost-effective means to reduce SSIs.
Level IV, systematic review of Level I-IV studies. See the Guidelines for Authors for a complete description of levels of evidence.
金黄色葡萄球菌是引起骨科手术部位感染（SSI）的最常见病原体。携带甲氧西林敏感金黄色葡萄球菌或耐甲氧西林金黄色葡萄球菌（MRSA）的患者更有可能发生侵袭性金黄色葡萄球菌感染。尽管有人主张对金黄色葡萄球菌进行筛查和去定植，但这些努力是否能降低 SSI 尚不清楚。
问题/目的：本研究的目的是确定（1）金黄色葡萄球菌筛查和去定植是否能降低骨科患者的 SSI 发生率，以及（2）实施该方案是否具有成本效益。
通过检索 PubMed 数据库，包括 MEDLINE（1946 年至今）、EMBASE.com（1974 年至今）和 Cochrane 图书馆的 Cochrane 系统评价数据库（CDSR）、Cochrane 对照试验中心注册库（CENTRAL）、效应摘要数据库（DARE）、卫生技术评估数据库（HTAD）和英国国家卫生与保健优化研究所经济评价数据库（NHSEED），确定本系统评价的研究。使用 EMTREE、MeSH 和关键词为每个去定植、MRSA 和骨科/骨科手术的搜索概念开发了全面的文献检索。排除了 1968 年以前发表的研究。我们分析了 19 项研究，这些研究评估了去定植方案降低 SSI 的能力，以及 10 项研究详细说明了金黄色葡萄球菌筛查和去定植的成本效益。
所有 19 项研究均表明，在择期骨科（关节置换、脊柱和运动）和创伤患者中实施金黄色葡萄球菌筛查和去定植方案可降低 SSI 或伤口并发症发生率。与 SSI 减少相关的成本相比，金黄色葡萄球菌筛查和去定植方案还为骨科患者节省了成本。
在骨科患者中进行金黄色葡萄球菌的术前筛查和去定植是降低 SSI 的一种具有成本效益的方法。
IV 级，对 I-IV 级研究的系统评价。有关证据等级的完整描述，请参见作者指南。
