Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
J Orthop Sci. 2023 Nov;28(6):1400-1406. doi: 10.1016/j.jos.2022.09.014. Epub 2022 Oct 7.
Staphylococcus aureus (S. aureus) nasal carriage is a well-known risk factor for surgical site infection (SSI) after total joint arthroplasty. This study aimed to compare the prevalence of S. aureus nasal carriage between patients with osteoarthritis (OA), a degenerative joint disease, and those with rheumatoid arthritis (RA), a chronic autoimmune inflammatory disease, who underwent total joint arthroplasty, and to investigate the influence of RA disease activity on nasal carriage rate.
This retrospective study targeted 508 OA and 107 RA patients who underwent S. aureus nasal screening prior to primary total knee and/or hip arthroplasty. RA patients were divided into two groups based on disease activity: the remission/low disease activity (REM/LDA) group and the moderate/high disease activity (MDA/HDA) group. Factors associated with S. aureus nasal carriage were assessed with multivariate logistic regression models.
Of all 615 patients, 155 (25%) carried S. aureus in their nares. Compared to OA patients, RA patients had a significantly higher rate of S. aureus nasal carriage (24% vs. 33%, p = 0.049). Compared to the REM/LDA group (n = 39), the MDA/HDA group (n = 58) had a significantly higher rate of S. aureus nasal carriage (21% vs. 41%, p = 0.032). Multivariate analysis revealed that the MDA/HDA group, but not the REM/LDA group, had a significantly higher odds of S. aureus nasal carriage compared to the OA group (odds ratio: 2.76, 95% confidence interval: 1.07-7.12).
Preoperative nasal screening for S. aureus is beneficial, especially in RA patients with moderate/high disease activity.
金黄色葡萄球菌（S. aureus）鼻腔携带是全关节置换术后手术部位感染（SSI）的一个已知危险因素。本研究旨在比较骨关节炎（OA）和类风湿关节炎（RA）患者全关节置换术前金黄色葡萄球菌鼻腔携带率，并探讨 RA 疾病活动度对鼻腔携带率的影响。
本回顾性研究纳入了 508 例 OA 和 107 例 RA 患者，这些患者在初次全膝关节和/或髋关节置换术前均进行了金黄色葡萄球菌鼻腔筛查。根据疾病活动度将 RA 患者分为缓解/低疾病活动度（REM/LDA）组和中/高疾病活动度（MDA/HDA）组。采用多变量逻辑回归模型评估与金黄色葡萄球菌鼻腔携带相关的因素。
在所有 615 例患者中，有 155 例（25%）鼻腔携带金黄色葡萄球菌。与 OA 患者相比，RA 患者金黄色葡萄球菌鼻腔携带率明显更高（24%比 33%，p=0.049）。与 REM/LDA 组（n=39）相比，MDA/HDA 组（n=58）金黄色葡萄球菌鼻腔携带率明显更高（21%比 41%，p=0.032）。多变量分析显示，与 OA 组相比，MDA/HDA 组而非 REM/LDA 组金黄色葡萄球菌鼻腔携带的优势比更高（比值比：2.76，95%置信区间：1.07-7.12）。
金黄色葡萄球菌鼻腔筛查有益，尤其是在中/高疾病活动度的 RA 患者中。
