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

Abstract

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.

Citation

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), Article e011642. https://doi.org/10.1136/bmjopen-2016-011642

• 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
• DOI: https://doi.org/10.1136/bmjopen-2016-011642
• Keywords: Staphylococcus aureus, screening, MSSA infections, orthopaedic patients,
• Public URL: http://researchrepository.napier.ac.uk/Output/385258