Relation between nasal carriage of Staphylococcus aureus and surgical site infection in orthopedic surgery: The role of nasal contamination. A systematic literature review and meta-analysis - 02/09/13

Doi : 10.1016/j.otsr.2013.03.030

P.-Y. Levy ^a, M. Ollivier ^b, M. Drancourt ^a,^b, D. Raoult ^a, J.-N. Argenson ^b,^⁎
^a Pôle maladies infectieuses et tropicales, faculté de médecine, université de la Méditerranée, clinique biologique, 27, boulevard Jean-Moulin, 13385 Marseille, France
^b Institut du mouvement et de l’appareil locomoteur, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France

^⁎Corresponding author. Tel.: +33 04 91 74 49 97.

conectar o crear una cuenta

Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
Artículo gratuito.

Conéctese para beneficiarse!

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Monday 02 September 2013
This article has been published in an issue click here to access

Summary

Staphylococcus aureus is the pathogen most frequently implicated in infection on orthopedic hardware; various strategies are deployed to limit the risk of transmission and surgical infection.

Objectives

The present study is based on a meta-analysis assessing firstly the relationship between nasal carriage of S. aureus and the development of osteo-articular infection and secondly current methods of decolonization.

Results

The meta-analysis showed increased risk of surgical site infection in case of nasal carriage of S. aureus: OR=5.92, 95% CI [1.15–30.39]; P=0.033. For cross-transmission, a scientifically proven reduction in surgical site S. aureus levels is ensured by associated mupirocin and 2% chlorhexidine antiseptic solution in subjects with positive nasal screening results for all surgical procedures taken together; the reduction was not, however, significant in the orthopedic surgery subgroup. The meta-analysis confirmed these findings: OR=0.60, 95% CI [0.34–1.06]; P=0.08.

Conclusion

The literature review confirmed that nasal carriage of S. aureus is a major risk factor for surgical site infection. The efficacy of eradication could not be demonstrated for orthopedic surgery as samples were too small. The positive trend found, however, should encourage further studies with sufficient power and risk/benefit should meanwhile be assessed on a case-by-case basis.