Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Asian J Surg. 2021 Jun;44(6):807-818. doi: 10.1016/j.asjsur.2020.12.037. Epub 2021 Jan 16.
The purpose of this study is to conduct a meta-analysis to evaluate the efficacy of screening and decolonization protocol for Staphylococcus aureus (SA) in total joint arthroplasty (TJA). We systematically searched the electronic databases of PubMed, Embase and Cochrane databases for relevant literatures from January 2000 to September 2020. The outcomes were colonization rate, total-surgical site infection (SSI) rate, SA-SSI rate and methicillin-resistant Staphylococcus aureus (MRSA)-SSI rate. All calculations and statistical tests were performed using Stata 14.0 software. A total of 12 studies were eligible in this study. Compared with control group, the screening and decolonization group had lower risks in total-SSI (risk ratio (RR) = 0.52; 95% confidence interval (CI): 0.40-0.67), SA-SSI (RR = 0.48; 95% CI: 0.32-0.72) and MRSA-SSI (RR = 0.45; 95% CI: 0.21-0.96). The nasal SA colonization was found to be associated with higher accidences of SSI involving total-SSI (RR = 1.49; 95% CI: 1.02-2.18), SA-SSI (RR = 2.51; 95% CI: 0.97-6.50) and MRSA-SSI (RR = 7.84; 95% CI: 1.67-36.79). The colonization rate of SA was significantly reduced after decolonization. No difference was observed between universal decolonization and screening-based decolonization. In conclusion, colonization of SA is associated with increased risk of SSI in TJA. Screening and decolonization protocol are proven to be effective to reduce colonization of SA and present protective effects against SSI in TJA. Moreover, universal decolonization protocol is non-inferior to screening-based decolonization.
本研究旨在进行荟萃分析，以评估金黄色葡萄球菌（SA）筛查和去定植方案在全关节置换术（TJA）中的疗效。我们系统地检索了 PubMed、Embase 和 Cochrane 数据库中 2000 年 1 月至 2020 年 9 月的相关文献。结果包括定植率、总手术部位感染（SSI）率、SA-SSI 率和耐甲氧西林金黄色葡萄球菌（MRSA）-SSI 率。所有计算和统计检验均使用 Stata 14.0 软件进行。本研究共纳入 12 项研究。与对照组相比，筛查和去定植组的总 SSI（风险比（RR）=0.52；95%置信区间（CI）：0.40-0.67）、SA-SSI（RR=0.48；95%CI：0.32-0.72）和 MRSA-SSI（RR=0.45；95%CI：0.21-0.96）风险较低。SA 的鼻腔定植与总 SSI（RR=1.49；95%CI：1.02-2.18）、SA-SSI（RR=2.51；95%CI：0.97-6.50）和 MRSA-SSI（RR=7.84；95%CI：1.67-36.79）发生率较高相关。去定植后，SA 的定植率显著降低。普遍去定植和基于筛查的去定植之间没有差异。综上所述，SA 的定植与 TJA 中的 SSI 风险增加有关。筛查和去定植方案已被证明可有效降低 SA 的定植率，并对 TJA 中的 SSI 具有保护作用。此外，普遍去定植方案并不逊于基于筛查的去定植方案。
