Mufarrih Syed H, Qureshi Nada Q, Sadruddin Anum, Hashmi Pervaiz, Mahmood Syed Faisal, Zafar Afia, Noordin Shahryar
Department of Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
JMIR Res Protoc. 2018 Jun 6;7(6):e10219. doi: 10.2196/10219.
Surgical site infections following total hip or knee arthroplasties have a reported rate of 0.49%-2.5% and can cause significant morbidity as well as tripling the cost of health care expenses. Both methicillin sensitive and methicillin resistant strains of Staphylococcus aureus surgical site infections have been established as a major risk factor for postoperative surgical site infections. S. aureus colonizes the nose, axillae, and perineal region in up to 20%-30% of individuals. Although the literature has reported a higher prevalence of methicillin resistant S. aureus in the South Asian population, routine preoperative screening and prophylaxis have not yet been implemented.
The primary objective of our study is to identify the relationship between preoperative colonization status of S. aureus and incidence of postoperative surgical site infections in patients undergoing following total hip and knee arthroplasties. As part of the secondary objectives of this study, we will also investigate patient characteristics acting as risk factors for S. aureus colonization as well as the outcomes of total hip and knee arthroplasty patients which are affected by surgical site infections.
This prospective cohort study will comprise of screening all patients older than 18 years of age admitted to the Aga Khan University Hospital for a primary total hip or knee arthroplasty for preoperative colonization with S. aureus. The patients will be followed postoperatively for up to one year following the surgery to assess the incidence of surgical site infections. The study duration will be 2 years (March 2018 to March 2020). For the purpose of screening, pooled swabs will be taken from the nose, axillae, and groin of each patient and inoculated in a brain heart infusion, followed by subculture onto mannitol salt agar and sheep blood agar. For methicillin resistant S. aureus identification, a cefoxitin disk screen will be done. Data will be analyzed using SPSS v23 and both univariate and multivariate regression analysis will be conducted.
Data collection for this study will commence at the Aga Khan University Hospital, Pakistan during March 2018.
This study will not only estimate the true burden caused by S. aureus in the population under study but will also help identify the patients at a high risk of surgical site infections so that appropriate interventions, including prophylaxis with antibiotics such as muciprocin ointment or linezolid, can be made. Given the differences in lifestyle, quality, and affordability of health care and the geographical variation in patterns of antibiotic resistance, this study will contribute significantly to providing incentive for routine screening and prophylaxis for S. aureus including methicillin resistant S. aureus colonization in the South Asian population.
RR1-10.2196/10219.
全髋关节或膝关节置换术后手术部位感染的报告发生率为0.49%-2.5%，可导致严重发病，并使医疗费用增加两倍。金黄色葡萄球菌手术部位感染的甲氧西林敏感株和耐甲氧西林株均已被确认为术后手术部位感染的主要危险因素。高达20%-30%的个体中，金黄色葡萄球菌定植于鼻腔、腋窝和会阴区域。尽管文献报道南亚人群中耐甲氧西林金黄色葡萄球菌的患病率较高，但尚未实施常规术前筛查和预防措施。
我们研究的主要目的是确定全髋关节和膝关节置换术后患者术前金黄色葡萄球菌定植状态与术后手术部位感染发生率之间的关系。作为本研究次要目的的一部分，我们还将调查作为金黄色葡萄球菌定植危险因素的患者特征，以及受手术部位感染影响的全髋关节和膝关节置换患者的结局。
这项前瞻性队列研究将包括对所有入住阿迦汗大学医院接受初次全髋关节或膝关节置换术的18岁以上患者进行术前金黄色葡萄球菌定植筛查。术后对患者进行长达一年的随访，以评估手术部位感染的发生率。研究持续时间为2年（2018年3月至2020年3月）。为了进行筛查，将从每位患者的鼻腔、腋窝和腹股沟采集混合拭子，接种于脑心浸液中，然后转种到甘露醇盐琼脂和羊血琼脂上。对于耐甲氧西林金黄色葡萄球菌的鉴定，将进行头孢西丁纸片筛查。数据将使用SPSS v23进行分析，并进行单变量和多变量回归分析。
本研究的数据收集将于2018年3月在巴基斯坦的阿迦汗大学医院开始。
本研究不仅将估计研究人群中金黄色葡萄球菌造成的实际负担，还将有助于识别手术部位感染高危患者，以便采取适当干预措施，包括使用莫匹罗星软膏或利奈唑胺等抗生素进行预防。鉴于医疗保健的生活方式、质量和可承受性存在差异，以及抗生素耐药模式的地理差异，本研究将为推动对包括南亚人群中耐甲氧西林金黄色葡萄球菌定植在内的金黄色葡萄球菌进行常规筛查和预防提供重要帮助。
RR1-10.2196/10219
