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Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus ? A part-retrospective case–control study in a Scottish hospital

Dancer, Stephanie J; Christison, Fraser; Eslami, Attaolah; Gregori, Alberto; Miller, Roslyn; Perisamy, Kumar; Robertson, Chris; Graves, Nick


Fraser Christison

Attaolah Eslami

Alberto Gregori

Roslyn Miller

Kumar Perisamy

Chris Robertson

Nick Graves


Background With recent focus on methicillin-resistant Staphylococcus aureus (MRSA) screening, methicillin-susceptible S. aureus (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery.

Methods We broadened MRSA screening to include MSSA for elective orthopaedic patients. Preoperative decolonisation was offered if appropriate. Elective and trauma patients were audited for staphylococcal infection during 2 6-month periods (A: January to June 2013 MRSA screening; B: January to June 2014 MRSA and MSSA screening). Trauma patients are not screened presurgery and provided a control. MSSA screening costs of a modelled cohort of 500 elective patients were offset by changes in number and costs of MSSA infections to demonstrate the change in total health service costs.

Findings Trauma patients showed similar infection rates during both periods (p=1). In period A, 4 (1.72%) and 15 (6.47%) of 232 elective patients suffered superficial and deep MSSA infections, respectively, with 6 superficial (2%) and 1 deep (0.3%) infection among 307 elective patients during period B. For any MSSA infection, risk ratios were 0.95 (95% CI 0.41 to 2.23) for trauma and 0.28 (95% CI 0.12 to 0.65) for elective patients (period B vs period A). For deep MSSA infections, risk ratios were 0.58 (95% CI 0.20 to 1.67) for trauma and 0.05 (95% CI 0.01 to 0.36) for elective patients (p=0.011). There were 29.12 fewer deep infections in the modelled cohort of 500 patients, with a cost reduction of £831 678 for 500 patients screened.

Conclusions MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits.


Dancer, S. J., Christison, F., Eslami, A., Gregori, A., Miller, R., Perisamy, K., …Graves, N. (2016). Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus ? A part-retrospective case–control study in a Scottish hospital. BMJ Open, 6(9),

Journal Article Type Article
Acceptance Date Aug 5, 2016
Online Publication Date Sep 6, 2016
Publication Date 2016-09
Deposit Date Sep 21, 2016
Publicly Available Date Sep 21, 2016
Journal BMJ Open
Print ISSN 2044-6055
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 6
Issue 9
Article Number e011642
Keywords Staphylococcus aureus, screening, MSSA infections, orthopaedic patients,
Public URL


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This is an Open Access article distributed in accordance with<br /> the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license,<br /> which permits others to distribute, remix, adapt, build upon this work noncommercially,<br /> and license their derivative works on different terms, provided<br /> the original work is properly cited and the use is non-commercial. See: http://<br />

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