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Research article
Hisahiro Tonotsuka
Funabashi Orthopaedic Sports Medicine Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5878-7916
License:
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Background: To reduce periprosthetic joint infection after total hip arthroplasty (THA), several nasal screening and decolonization strategies for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) have been performed. These include universal decolonization (UD; i.e., no screening and decolonization for all patients), universal screening and target decolonization (US; i.e., screening for all patients and decolonization for bacterial positive patients), and target screening and decolonization (TS; i.e., screening and decolonization for high-risk populations only). Although TS is the most cost-effective strategy, useful risk factors must be identified. The purpose of this study was to evaluate the presence of predictive factors that enable the TS strategy to be successfully implemented and to compare the costs of each strategy.
Methods: A total of 1654 patients scheduled for primary or revision THA (1464 females, 190 males; mean age 64 years) were screened prior to surgery for bacterial colonization of the nasal mucosa. Risk factors for positive MRSA and S. aureus (including both MRSA and MSSA) tests were analyzed according to the following parameters: sex, age ≥80 years, body mass index ≥30 kg/m2, antibiotic use within 3 years, corticosteroid use, serum albumin <3.5 g/dL, glomerular filtration rate <50 mL/min, presence of brain, thyroid, cardiac or pulmonary disease, diabetes, asthma, smoking status, and whether revision surgery was performed. The average cost of each strategy was calculated.
Results: In total, 29 patients (1.8%) tested positive for MRSA and 445 (26.9%) tested positive for S. aureus. No parameters were identified as independent risk factors for MRSA and only female sex was identified as a risk factor for S. aureus (p=0.003; odds ratio: 1.790; 95% confidence interval: 1.210-2.640). The average cost of each strategy was 1928.3 yen for UD, 717.6 yen for US, and 717.6 yen for TS (for eradicating MRSA), and 1928.3 yen for UD, 1201.6 yen for US, and 1160.4 yen for TS (for eradicating S. aureus).
Conclusions: No useful predictive parameters for implementing the TS strategy were identified. Based on cost implications, US is the most cost-effective strategy for THA patients.
Keywords
Total hip arthroplasty, Staphylococcus aureus, Periprosthetic joint infection, Nasal decolonization, Screening
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CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
Version 2
Posted 21 Dec, 2020
No community comments so far
Editorial decision: Minor revision
On 10 Jan, 2021
Review #1 received
Received 02 Jan, 2021
Review #2 received
Received 01 Jan, 2021
Reviewer #2 agreed
On 19 Dec, 2020
Reviewers invited
Invitations sent on 16 Dec, 2020
Reviewer #1 agreed
On 16 Dec, 2020
Editor assigned
On 06 Dec, 2020
Submission checks complete
On 06 Dec, 2020
Editor invited
On 06 Dec, 2020
No comments provided
Editorial decision: Major revision
On 08 Nov, 2020
Review #3 received
Received 04 Nov, 2020
Reviewer #3 agreed
On 27 Oct, 2020
Review #2 received
Received 19 Oct, 2020
Review #1 received
Received 04 Aug, 2020
Reviewer #2 agreed
On 19 Jul, 2020
Reviewer #1 agreed
On 12 Jul, 2020
Reviewers invited
Invitations sent on 08 Jul, 2020
Editor assigned
On 01 Jul, 2020
Submission checks complete
On 22 Jun, 2020
Editor invited
On 22 Jun, 2020
First submitted
On 15 Jun, 2020
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Subject Areas
Orthopedics
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A new preprint design is coming!
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See the published version of this preprint at BMC Musculoskeletal Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Hisahiro Tonotsuka
Funabashi Orthopaedic Sports Medicine Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5878-7916
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
Version 2
Posted 21 Dec, 2020
No community comments so far
Editorial decision: Minor revision
On 10 Jan, 2021
Review #1 received
Received 02 Jan, 2021
Review #2 received
Received 01 Jan, 2021
Reviewer #2 agreed
On 19 Dec, 2020
Reviewers invited
Invitations sent on 16 Dec, 2020
Reviewer #1 agreed
On 16 Dec, 2020
Editor assigned
On 06 Dec, 2020
Submission checks complete
On 06 Dec, 2020
Editor invited
On 06 Dec, 2020
No comments provided
Editorial decision: Major revision
On 08 Nov, 2020
Review #3 received
Received 04 Nov, 2020
Reviewer #3 agreed
On 27 Oct, 2020
Review #2 received
Received 19 Oct, 2020
Review #1 received
Received 04 Aug, 2020
Reviewer #2 agreed
On 19 Jul, 2020
Reviewer #1 agreed
On 12 Jul, 2020
Reviewers invited
Invitations sent on 08 Jul, 2020
Editor assigned
On 01 Jul, 2020
Submission checks complete
On 22 Jun, 2020
Editor invited
On 22 Jun, 2020
First submitted
On 15 Jun, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Musculoskeletal Disorders.
Background: To reduce periprosthetic joint infection after total hip arthroplasty (THA), several nasal screening and decolonization strategies for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) have been performed. These include universal decolonization (UD; i.e., no screening and decolonization for all patients), universal screening and target decolonization (US; i.e., screening for all patients and decolonization for bacterial positive patients), and target screening and decolonization (TS; i.e., screening and decolonization for high-risk populations only). Although TS is the most cost-effective strategy, useful risk factors must be identified. The purpose of this study was to evaluate the presence of predictive factors that enable the TS strategy to be successfully implemented and to compare the costs of each strategy.
Methods: A total of 1654 patients scheduled for primary or revision THA (1464 females, 190 males; mean age 64 years) were screened prior to surgery for bacterial colonization of the nasal mucosa. Risk factors for positive MRSA and S. aureus (including both MRSA and MSSA) tests were analyzed according to the following parameters: sex, age ≥80 years, body mass index ≥30 kg/m2, antibiotic use within 3 years, corticosteroid use, serum albumin <3.5 g/dL, glomerular filtration rate <50 mL/min, presence of brain, thyroid, cardiac or pulmonary disease, diabetes, asthma, smoking status, and whether revision surgery was performed. The average cost of each strategy was calculated.
Results: In total, 29 patients (1.8%) tested positive for MRSA and 445 (26.9%) tested positive for S. aureus. No parameters were identified as independent risk factors for MRSA and only female sex was identified as a risk factor for S. aureus (p=0.003; odds ratio: 1.790; 95% confidence interval: 1.210-2.640). The average cost of each strategy was 1928.3 yen for UD, 717.6 yen for US, and 717.6 yen for TS (for eradicating MRSA), and 1928.3 yen for UD, 1201.6 yen for US, and 1160.4 yen for TS (for eradicating S. aureus).
Conclusions: No useful predictive parameters for implementing the TS strategy were identified. Based on cost implications, US is the most cost-effective strategy for THA patients.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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