Is nasal carriage of Staphylococcus aureus the main acquisition pathway for surgical-site infection in orthopaedic surgery?

• Published in: European journal of clinical microbiology & infectious diseases Vol. 29; no. 4; pp. 373 - 382
• Main Authors: Berthelot, P., Grattard, F., Cazorla, C., Passot, J.-P., Fayard, J.-P., Meley, R., Bejuy, J., Farizon, F., Pozzetto, B., Lucht, F.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.04.2010; Springer; Springer Nature B.V
• Subjects: Aged; Bacterial diseases; Bacterial Typing Techniques; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Carrier State - epidemiology; Carrier State - microbiology; Cohort analysis; Disease prevention; DNA Fingerprinting; Electrophoresis, Gel, Pulsed-Field; Female; General aspects; Genotype; Hospitals; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; Infectious diseases; Internal Medicine; Male; Medical Microbiology; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Multivariate analysis; Nose; Older people; Orthopedic surgery; Orthopedics; Patients; Prospective Studies; Prostheses; Risk Factors; Staphylococcal Infections - microbiology; Staphylococcal Infections - transmission; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus - classification; Staphylococcus aureus - isolation & purification; Staphylococcus infections; Surgeons; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical site infections; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; France; United States > US; Prosthetic Joint Infection; Nasal Sample; Mupirocin; Anterior Nare; Nasal Carriage; Surgical wound; Nosocomial infection; Microbiology; Nasopharynx; Infection; Orthopedic surgery; Treatment; Nose; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Staphylococcal infection; Colonization; Staphylococcus aureus
• ISSN: 0934-9723; 1435-4373; 1435-4373
• DOI: 10.1007/s10096-009-0867-5

The endogenous or exogenous origin of Staphylococcus aureus , responsible for orthopaedic surgical-site infections (SSI), remains debated. We conducted a multicentre prospective cohort study to analyse the respective part of exogenous contamination and endogenous self-inoculation by S. aureus during elective orthopaedic surgery. The nose of each consecutive patient was sampled before surgery. Strains of S. aureus isolated from the nose and the wound, in the case of SSI, were compared by antibiotypes or pulsed-field gel electrophoresis (PFGE). A total of 3,908 consecutive patients undergoing orthopaedic surgery were included. Seventy-seven patients developed an SSI (2%), including 22 related to S. aureus (0.6%). S. aureus was isolated from the nose of 790 patients (20.2%) at the time of surgery. In the multivariate analysis, S. aureus nasal carriage was found to be a risk factor for S. aureus SSI in orthopaedic surgery. However, only nine subjects exhibiting S. aureus SSI had been found to be carriers before surgery: when compared, three pairs of strains were considered to be different and six similar. In most cases of S. aureus SSI, either an endogenous origin could not be demonstrated or pre-operative nasal colonisation retrieved a strain that was different from the one recovered from the surgical site