MRSA Screening and Decolonisation in Joint replacement Arthroplasty and its outcome in a tertiary care Orthopaedic centre in Bangalore

Abstract

Background: Surgical site Infections (SSIs) are a major source of morbidity and mortality for patients undergoing total arthroplasty either hip or knee replacement surgeries. Methicillin resistant Staphylococcus aureus (MRSA) colonization is an independent, modifiable risk factor for periprosthetic joint infections and SSIs. Post-operative infections are reported to be ten times greater in MRSA carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. The aim of this study was to determine the efficacy of MRSA Screening and treatment prior to elective Arthroplasty cases in a tertiary care orthopaedic center in Bangalore. Methods: A Retrospective study was performed from 1 January 2018  to 30 September 2020. All patients who underwent primary unilateral arthroplasties of knee or hip during this period were included in the study. From January 2019, MRSA screening for all Arthroplasty elective cases became mandatory in our Institute and we collected 26 consecutive MRSA Positive cases for the study. We took 26 controls from January 2018 to December 2018 who did not undergo screening for MRSA. They were divided into Group A and Group B respectively. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using Student’s t-tests, Fisher’s extract tests, and chi-square analyses and Leven’s test for homogeneity of variance was used.Conclusion: The Pre-operative screening of MRSA by nasal swab culture and sensitivity test for all Arthroplasty case is certainly a cost effective and effective in containing post-operative MRSA infection including SSI.Although the p value in this study was of suggestive significance withp value 0.109, we recommend pre-operative screening for MRSA and decolonisation of MRSA positive cases for all elective Arthroplasty cases especially knee replacement surgeries.