Department of Orthopedics, Centro Hospitalar do Porto, Porto, Portugal.
Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
J Arthroplasty. 2021 Feb;36(2):752-766.e6. doi: 10.1016/j.arth.2020.08.014. Epub 2020 Aug 14.
Staphylococcus aureus is a major pathogen implicated in orthopedic infections worldwide. Preoperative decolonization has been promoted but different strategies present mixed results. Thus, the goals of this study are to determine (1) whether S aureus screening and/or decolonization is effective at reducing surgical site infection in orthopedic surgery, (2) with a special focus on elective total joint arthroplasty (TJA), and (3) which preoperative S aureus screening/treatment strategy is most cost-effective for TJA.
PubMed, Ovid MEDLINE, and Cochrane databases were searched on January 1, 2020, using a systematic strategy. We included papers with data comparing surgical site infection and periprosthetic joint infection rate in orthopedic surgery and/or elective total hip and knee arthroplasty patients before/after S aureus screening and/or decolonization protocol and papers evaluating the cost-effectiveness of different S aureus screening/treatment strategies.
A total of 1260 papers were screened, and 32 papers were ultimately included. Results showed an increased risk of developing any infection (relative risk [RR] = 1.71 ± 0.16) and S aureus infection (RR = 2.79 ± 0.45) after orthopedic surgery without previous nares and whole-body decolonization. Focusing exclusively on elective TJA, there was an increased risk of developing any infection (RR = 1.70 ± 0.17) and S aureus infection (RR = 2.18 ± 0.41) if no decolonization is performed. All strategies appeared to be cost-effective, although universal decolonization without screening seemed to be the most advantageous.
Preoperative S aureus screening/decolonization protocol lowered the risk of infection after elective orthopedic and TJA surgeries. However, further studies are needed to determine optimal clinical and cost-effective methodologies.
金黄色葡萄球菌是一种全球范围内与骨科感染相关的主要病原体。术前去定植已被提倡，但不同的策略结果不一。因此，本研究的目的是确定（1）金黄色葡萄球菌筛查和/或去定植是否能有效降低骨科手术中的手术部位感染，（2）特别关注择期全关节置换术（TJA），以及（3）哪种术前金黄色葡萄球菌筛查/治疗策略对 TJA 最具成本效益。
2020 年 1 月 1 日，我们使用系统策略在 PubMed、Ovid MEDLINE 和 Cochrane 数据库中进行了搜索。我们纳入了比较金黄色葡萄球菌筛查和/或去定植方案前后骨科手术和/或择期全髋关节和膝关节置换术患者手术部位感染和假体周围关节感染发生率的论文，以及评估不同金黄色葡萄球菌筛查/治疗策略成本效益的论文。
共筛选出 1260 篇论文，最终纳入 32 篇论文。结果显示，在没有术前鼻腔和全身去定植的情况下，骨科手术后发生任何感染（相对风险 [RR] = 1.71 ± 0.16）和金黄色葡萄球菌感染（RR = 2.79 ± 0.45）的风险增加。如果不进行去定植，仅专注于择期 TJA，发生任何感染（RR = 1.70 ± 0.17）和金黄色葡萄球菌感染（RR = 2.18 ± 0.41）的风险增加。所有策略似乎都具有成本效益，尽管不进行筛查的普遍去定植似乎最有利。
术前金黄色葡萄球菌筛查/去定植方案降低了择期骨科和 TJA 手术后感染的风险。然而，需要进一步研究以确定最佳的临床和成本效益方法。
