Clinical Efficacy of Nasal Screening and Methicillin-Resistant Staphylococcusaureus Decolonization in Total Hip Arthroplasty without Chlorhexidine Soap or Vancomycin

Masahiko Mihara; Kazuo Hirakawa; Satoshi Takayanagi; Daigo Kobayashi; Akira Morita; Yushi Miyamae

doi:10.1007/s43465-024-01109-3

Clinical Efficacy of Nasal Screening and Methicillin-Resistant Staphylococcusaureus Decolonization in Total Hip Arthroplasty without Chlorhexidine Soap or Vancomycin

Indian J Orthop. 2024 Mar 1;58(4):412-416. doi: 10.1007/s43465-024-01109-3. eCollection 2024 Apr.

Authors

Masahiko Mihara¹, Kazuo Hirakawa¹, Satoshi Takayanagi¹, Daigo Kobayashi¹, Akira Morita¹, Yushi Miyamae²

Affiliations

¹ Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061 Japan.
² Shin-Yurigaoka General Hospital, 255 Hurusawa-Tuko Asaoku, Kawasaki, Kanagawa 215-0026 Japan.

PMID: 38544538
PMCID: PMC10963709 (available on 2025-03-01)
DOI: 10.1007/s43465-024-01109-3

Abstract

Purpose: Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a known risk factor for periprosthetic joint infection (PJI). In our facility, preoperative prophylaxis with mupirocin without the chlorhexidine soap scrub or vancomycin was consistently implemented for more than 15 years. This study aimed to evaluate the current screening and treatment of intranasal MRSA colonization in our elective primary THA patient population.

Methods: All patients who underwent primary THA between April 2011, and March 2021 were included in this analysis. All patients were screened preoperatively for nasal MRSA approximately 1 month before surgery. Patients with nasal MRSA contamination are treated with topical mupirocin to eradicate the bacteria before surgery. The patients were examined again approximately two weeks before surgery. We evaluated the current screening and treatment of intranasal colonization with MRSA in our elective primary total hip arthroplasty (THA) patient population.

Results: Out of 6251 patients, 106 (1.7%) had nasal MRSA contamination. The bacteria were not eradicated in three (3.6%) patients at the second screening. Twenty-two joints (0.35%) out of the 6251 had deep infections. Only 1 patient out of the 106 MRSA nasal carriers suffered from PJI. Twenty-one of the 6145 non-carriers had PJI. The difference between the prevalence of nasal MRSA contamination and the incidence of deep infections was not statistically significant.

Conclusion: Our findings suggest that screening of all patients for nasal MRSA before THA followed by mupirocin calcium treatment if needed is sufficient PJI prophylaxis.

Keywords: Decolonization; Methicillin-resistant Staphylococcusaureus; Mupirocin calcium; Nasal screening; Total hip arthroplasty.

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