Program Schedule

Enhanced Detection of Staphylococcus aureus Colonization in Patients Undergoing Total Joint Arthroplasty

Session: Poster Abstract Session: Approach to Clinical Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • Enhanced detection of S aureus IDSA poster PDF.pdf (289.3 kB)
  • Background:   Prosthetic joint infections (PJI) often result in multiple surgeries and long-term antibiotic administration, along with substantially increased healthcare costs.  Due to the catastrophic nature of these infections and the increasing number of patients undergoing total joint arthroplasty (TJA), attention has turned to the development of prevention strategies for PJI.  Studies have shown that colonization with S. aureus is a risk factor for surgical site infection, but few data are available on S. aureus colonization in patients undergoing TJA.  This study sought to determine which anatomic site(s) are most frequently colonized with S. aureus in patients undergoing TJA, and to evaluate the utility of a preoperative questionnaire to predict S. aureus colonization.

    Methods:   A cross-sectional study was performed on patients undergoing TJA at an academic medical center.  A questionnaire assessing medical history and potential risk factors for S. aureus colonization was administered at a routine preoperative visit.  Patients were cultured for S. aureus in the nares, oropharynx (OP), axilla, groin and the proposed surgical site.

    Results: Sixty six of the 232 patients in the study (28%) were found to be colonized with S. aureus, including 19 patients (8%) colonized with MRSA.  The nares, OP and groin were the most common sites of colonization; detecting 80%, 36% and 15% of the colonized patients respectively.  None of the variables assessed in the questionnaire were found to be significantly associated with S. aureus colonization, although having a household member with a history of S. aureus approached significance (p=0.08).

    Conclusion: S. aureus colonization is common in patients undergoing TJA, and the MRSA colonization rate of 8% is relatively high compared with other study populations.  Sampled together, the nares and OP had a sensitivity of 92%, which increased to 97% when the groin site culture was added, indicating these as optimal screening sites.  Awareness of S. aureus colonization status may assist with infection prevention strategies, including the use of decolonization protocols and adjustment of perioperative antimicrobial regimens.  An infection risk assessment questionnaire was not helpful in predicting S. aureus colonization.

    Angela Hewlett, MD, MS1,2,3, Tyler White, BS4, Andrew Taiber, MD2, Dana Schwarz, RN MS2, Dillon Ellis, BS2, Paul Fey, PhD5, Elizabeth Lyden, MS3, Kevin Garvin, MD2, Beau Konigsberg, MD2 and Curtis Hartman, MD2, (1)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (2)Dept. of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, (3)College of Public Health, University of Nebraska Medical Center, Omaha, NE, (4)School of Medicine, University of Nebraska Medical Center, Omaha, NE, (5)Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE


    A. Hewlett, None

    T. White, None

    A. Taiber, None

    D. Schwarz, None

    D. Ellis, None

    P. Fey, None

    E. Lyden, None

    K. Garvin, None

    B. Konigsberg, None

    C. Hartman, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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