PDF(Pubmed)
Abstract：
BACKGROUND: Nasal carriage of Staphylococcus aureus is a risk factor for surgical site infections (SSI) in orthopaedic surgery. The efficacy of decolonisation for S. aureus on reducing the risk of SSI is uncertain in this speciality. The objective was to evaluate the impact of a nasal screening strategy of S. aureus and targeted decolonisation on the risk of S. aureus SSI.
METHODS: A retrospective pre-post and here-elsewhere study was conducted between January 2014 and June 2020 in 2 adult orthopaedic surgical sites (North and South) of a French university hospital. Decolonisation with Mupirocin and Chlorhexidine was conducted in S. aureus carriers starting February 2017 in the South site (intervention group). Scheduled surgical procedures for hip, knee arthroplasties, and osteosyntheses were included and monitored for one year. The rates of S. aureus SSI in the intervention group were compared to a historical control group (South site) and a North control group. The risk factors for S. aureus SSI were analysed by logistic regression.
RESULTS: A total of 5,348 surgical procedures was included, 100 SSI of which 30 monomicrobial S. aureus SSI were identified. The preoperative screening result was available for 60% (1,382/2,305) of the intervention group patients. Among these screenings, 25.3% (349/1,382) were positive for S. aureus and the efficacy of the decolonisation was 91.6% (98/107). The rate of S. aureus SSI in the intervention group (0.3%, 7/2,305) was not significantly different from the historical control group (0.5%, 9/1926) but differed significantly from the North control group (1.3%, 14/1,117). After adjustment, the risk factors of S. aureus SSI occurrence were the body mass index (ORaper unit, 1.05; 95%CI, 1.0-1.1), the Charlson comorbidity index (ORaper point, 1.34; 95%CI, 1.0-1.8) and operative time (ORaper minute, 1.01; 95%CI, 1.00-1.02). Having benefited from S. aureus screening/decolonisation was a protective factor (ORa, 0.24; 95%CI, 0.08-0.73).
CONCLUSIONS: Despite the low number of SSI, nasal screening and targeted decolonisation of S. aureus were associated with a reduction in S. aureus SSI.
METHODS: A retrospective pre-post and here-elsewhere study was conducted between January 2014 and June 2020 in 2 adult orthopaedic surgical sites (North and South) of a French university hospital. Decolonisation with Mupirocin and Chlorhexidine was conducted in S. aureus carriers starting February 2017 in the South site (intervention group). Scheduled surgical procedures for hip, knee arthroplasties, and osteosyntheses were included and monitored for one year. The rates of S. aureus SSI in the intervention group were compared to a historical control group (South site) and a North control group. The risk factors for S. aureus SSI were analysed by logistic regression.
RESULTS: A total of 5,348 surgical procedures was included, 100 SSI of which 30 monomicrobial S. aureus SSI were identified. The preoperative screening result was available for 60% (1,382/2,305) of the intervention group patients. Among these screenings, 25.3% (349/1,382) were positive for S. aureus and the efficacy of the decolonisation was 91.6% (98/107). The rate of S. aureus SSI in the intervention group (0.3%, 7/2,305) was not significantly different from the historical control group (0.5%, 9/1926) but differed significantly from the North control group (1.3%, 14/1,117). After adjustment, the risk factors of S. aureus SSI occurrence were the body mass index (ORaper unit, 1.05; 95%CI, 1.0-1.1), the Charlson comorbidity index (ORaper point, 1.34; 95%CI, 1.0-1.8) and operative time (ORaper minute, 1.01; 95%CI, 1.00-1.02). Having benefited from S. aureus screening/decolonisation was a protective factor (ORa, 0.24; 95%CI, 0.08-0.73).
CONCLUSIONS: Despite the low number of SSI, nasal screening and targeted decolonisation of S. aureus were associated with a reduction in S. aureus SSI.
摘要：
背景：金黄色葡萄球菌的鼻腔携带是骨科手术中手术部位感染（SSI）的危险因素。金黄色葡萄球菌脱色在降低SSI风险方面的功效在该专业中是不确定的。目的是评估金黄色葡萄球菌的鼻部筛查策略和靶向脱色对金黄色葡萄球菌SSI风险的影响。
方法：2014年1月至2020年6月，在法国大学医院的2个成人骨科手术地点（南北）进行了一项回顾性研究。从2017年2月开始，在南部地区（干预组）的金黄色葡萄球菌携带者中使用莫匹罗星和氯己定进行了脱氮。预定的髋部外科手术，膝关节置换术，和骨合成被纳入并监测了一年。将干预组的金黄色葡萄球菌SSI率与历史对照组（南部站点）和北部对照组进行比较。采用Logistic回归分析金黄色葡萄球菌SSI的危险因素。
结果：共纳入5,348次外科手术，100个SSI,其中鉴定出30个单抗微生物金黄色葡萄球菌SSI。60％（1,382/2,305）的干预组患者可获得术前筛查结果。在这些放映中，25.3%(349/1,382)的金黄色葡萄球菌为阳性,脱色的效力为91.6%(98/107)。干预组金黄色葡萄球菌SSI发生率(0.3%,7/2,305）与历史对照组（0.5%，1926年9月9日)，但与北方对照组(1.3%，14/1,117）。调整后,金黄色葡萄球菌SSI发生的危险因素是体重指数(ORaper单位，1.05;95CI,1.0-1.1),Charlson合并症指数(ORaper点，1.34;95CI，1.0-1.8)和手术时间(ORaper分钟，1.01；95CI，1.00-1.02）。受益于金黄色葡萄球菌筛查/脱色是一个保护因素(ORa，0.24；95CI，0.08-0.73）。
结论：尽管SSI的数量很少，金黄色葡萄球菌的鼻部筛查和靶向脱色与金黄色葡萄球菌SSI的减少相关.
方法：2014年1月至2020年6月，在法国大学医院的2个成人骨科手术地点（南北）进行了一项回顾性研究。从2017年2月开始，在南部地区（干预组）的金黄色葡萄球菌携带者中使用莫匹罗星和氯己定进行了脱氮。预定的髋部外科手术，膝关节置换术，和骨合成被纳入并监测了一年。将干预组的金黄色葡萄球菌SSI率与历史对照组（南部站点）和北部对照组进行比较。采用Logistic回归分析金黄色葡萄球菌SSI的危险因素。
结果：共纳入5,348次外科手术，100个SSI,其中鉴定出30个单抗微生物金黄色葡萄球菌SSI。60％（1,382/2,305）的干预组患者可获得术前筛查结果。在这些放映中，25.3%(349/1,382)的金黄色葡萄球菌为阳性,脱色的效力为91.6%(98/107)。干预组金黄色葡萄球菌SSI发生率(0.3%,7/2,305）与历史对照组（0.5%，1926年9月9日)，但与北方对照组(1.3%，14/1,117）。调整后,金黄色葡萄球菌SSI发生的危险因素是体重指数(ORaper单位，1.05;95CI,1.0-1.1),Charlson合并症指数(ORaper点，1.34;95CI，1.0-1.8)和手术时间(ORaper分钟，1.01；95CI，1.00-1.02）。受益于金黄色葡萄球菌筛查/脱色是一个保护因素(ORa，0.24；95CI，0.08-0.73）。
结论：尽管SSI的数量很少，金黄色葡萄球菌的鼻部筛查和靶向脱色与金黄色葡萄球菌SSI的减少相关.
