scholarly journals Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Xingyang Zhu ◽  
Xiaobo Sun ◽  
Yuqing Zeng ◽  
Wenjun Feng ◽  
Jie Li ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Total Joint Arthroplasty ◽  
Meta Analysis ◽  
Bacterial Species ◽  
Surgical Site Infections ◽  
Joint Arthroplasty ◽  
Cochrane Library ◽  
Superficial Infection ◽  
Joint Infections ◽  
The Impact

Abstract Background Nasal Staphylococcus aureus (S. aureus) screening and decolonization has been widely used to reduce surgical site infections (SSIs) prior to total knee and hip arthroplasty (TKA and THA). However, it remains considerably controversial. The aim of this study was to ascertain whether this scheme could reduce SSIs and periprosthetic joint infections (PJIs) following elective primary total joint arthroplasty (TJA). Methods A systematic search was performed in MEDLINE, Embase, and the Cochrane Library until October, 2019. Outcomes of interest included SSI, PJI, superficial infection, and different bacterial species that caused infections. Data from eligible studies were then extracted and synthesized. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated. We also performed additional analyses to evaluate whether there were differences in postoperative SSIs caused by S. aureus or other bacteria. Results Nine studies were included in our meta-analysis. The pooled data elucidated that nasal S. aureus screening and decolonization dramatically mitigated the risk of SSI, PJI, and superficial infection compared to nondecolonization group. The analysis of bacterial species causing infection also showed that the S. aureus infections postoperative were significantly decreased in the decolonization group. However, there was no statistical difference in the SSI caused by other bacteria between the two groups. Conclusion S. aureus screening and decolonization prior to elective primary THA and TKA could significantly decrease the risk of SSI and PJI. However, more robust studies are needed to further evaluate the impact of S. aureus screening and decolonization on infection risk after TJA.

scholarly journals Efficacy of hydrofibre dressing following total joint arthroplasty: a meta-analysis of randomised controlled trials

2021 ◽  
pp. 112070002110126
Author(s):  
Raman Mundi ◽  
Harman Chaudhry ◽  
Seper Ekhtiari ◽  
Prabjit Ajrawat ◽  
Daniel M Tushinski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Joint Arthroplasty ◽  
Meta Analysis ◽  
Joint Infection ◽  
The United States ◽  
Joint Arthroplasty ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Observable Effect ◽  
The Impact

Introduction: In the United States, over 1,000,000 total joint arthroplasty (TJA) surgeries are performed annually and has been forecasted that this number will exceed 4,000,000 by the year 2030. Many different types of dressing exist for use in TJA surgery, and it is unclear if any of the newer, hydrofibre dressings are superior to traditional dressings at reducing rates of infections or improving wound healing. Thus, the aim of this systematic review and meta-analysis was to assess the impact of hydrofiber dressings on reducing complications. Methods: A systematic review and meta-analysis was performed using the online databases MEDLINE and the Cochrane Library. Randomized controlled trials (RCTs) comparing hydrofibre dressings to a standard dressing were included. Summary measures are reported as odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Our primary outcome was prosthetic joint infection (PJI). Secondary outcomes included blisters, dressing changes and wound irritation. Results: 5 RCTs were included. Hydrofibre dressing had no observable effect on PJI or wound irritation (OR 0.53; 95% CI, 0.14–1.98; p = 0.35). Hydrofibre dressings reduced the rate of blisters (OR 0.36; 95% CI, 0.14–0.90; p = 0.03) and number of dressing changes (MD -1.89; 95% CI, -2.68 to -1.11). Conclusions: In conclusion, evidence suggests hydrofibre dressings have no observable effect on PJI and wound irritation. Evidence for reduction in blisters and number of dressings is modest given wide CIs and biased trial methodologies. Use of hydrofibre dressings should be considered inconclusive for mitigating major complications in light of current best evidence.

scholarly journals Impact of Prior Intra-articular Injections on the Risk of Prosthetic Joint Infection Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Fei Nie ◽  
Wei Li
Keyword(s):  
Systematic Review ◽  
Prosthetic Joint Infection ◽  
Total Joint Arthroplasty ◽  
Meta Analysis ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Injection Group ◽  
Prosthetic Joint ◽  
Increased Risk ◽  
The Impact

Objective: The current review was designed to assess the impact of prior intra-articular injections on the risk of prosthetic joint infection (PJI) in patients undergoing total joint arthroplasty (TJA) with a focus on the timing of injection before surgery.Methods: The databases of PubMed, Embase and Google Scholar were searched up to 15th June 2021. All studies comparing the incidence of PJI with and without prior intra-articular injections were included. Risk ratios (RR) with 95% confidence intervals were calculated for PJI.Results: Nineteen studies were included. Both corticosteroids and hyaluronic acid injections were used before TJA in the included studies. Overall, comparing 127,163 patients with prior intra-articular injections and 394,104 patients without any injections, we noted a statistically significant increased risk of PJI in the injection group (RR 1.24 95% CI: 1.11, 1.38 I2 = 48% p = 0.002). On subgroup analysis, there was a statistically significant increased risk of PJI in the injection group in studies where intra-articular injections were administered <12 months before surgery (RR 1.18 95% CI: 1.10, 1.27 I2 = 7% p < 0.00001). Furthermore, on meta-analysis, we noted non-significant but increased risk of PJI when injections were administered 1 month (RR 1.47 95% CI: 0.88, 2.46 I2 = 77% p = 0.14), 0–3 months (RR 1.22 95% CI: 0.96, 1.56 I2 = 84% p = 0.11), and 3–6 months (RR 1.16 95% CI: 0.99, 1.35 I2 = 49% p = 0.06) before surgery.Conclusion: Our results indicate that patients with prior intra-articular injections have a small but statistically significant increased risk of PJI after TJA. Considering that PJI is a catastrophic complication with huge financial burden, morbidity and mortality; the clinical significance of this small risk cannot be dismissed. The question of the timing of injections and the risk of PJI still remains and can have a significant impact on the decision making.Systematic Review Registration: PROSPERO: CRD42021258297.

scholarly journals Nasal Decolonization of Staphylococcus Aureus and the Risk of Surgical Site Infection After Surgery: A Meta-Analysis

2020 ◽  
Author(s):  
Jia Tang ◽  
Jiangjin Hui ◽  
Jing Ma ◽  
Mingquan Chen
Keyword(s):  
Staphylococcus Aureus ◽  
Web Of Science ◽  
Meta Analysis ◽  
Surgical Site Infections ◽  
Cochrane Library ◽  
Randomized Controlled ◽  
Pulmonary Surgery ◽  
Different Types ◽  
The Cochrane Library ◽  
Risk Ratios

Abstract Aim: To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are S aureus carriers undergoing different types of surgeries. Methods: Relevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries that S aureus carriers were applied.Results: Twenty RCTs published between 1996 and 2019 involving 10526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR=0.59 and 0.47, respectively, both p<0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies.Conclusion: It seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSI in these patients, especially in patients receiving pulmonary surgeries.

scholarly journals Efficacy of proprioceptive training on the recovery of total joint arthroplasty patients: a meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Wen-chao Zhang ◽  
Deng Xiao
Keyword(s):  
Quality Of Life ◽  
Total Joint Arthroplasty ◽  
Balance Control ◽  
Meta Analysis ◽  
Balance Training ◽  
Joint Arthroplasty ◽  
Cochrane Library ◽  
Control Group ◽  
Study Objective

Abstract Background Optimal balance control is of paramount importance for function recovery after total joint arthroplasty (TJA). The study objective of this meta-analysis was to assess the short- and mid-term effects of proprioceptive and balance training for patients undergoing TJA. Methods Electronic searches were conducted from PubMed, Cochrane library, and Embase databases to identify eligible RCTs through May 2020. Standard mean difference (SMD) with 95% confidence interval (95%CI) was applied to calculate pooled effect estimates between proprioceptive and balance training and control group. Main outcomes were self-reported functionality, balance, pain, quality of life, and function (range of motion). Results Seven randomized controlled trials were finally included in this meta-analysis. Pooled results found that balance and proprioceptive trainings have a positive role in improving self-reported functionality at short-term after TJA. Moreover, balance and proprioceptive trainings were associated with an increase of the balance at short- and mid-term after TJA. These results were further confirmed by subgroup analysis between preoperative and postoperative administration of balance and proprioceptive trainings. Conclusion Our meta-analysis suggests that balance and proprioceptive trainings after TJA improved self-reported functionality and balance. These improvements were maintained at mid-terms. More research is needed to confirm balance and proprioceptive trainings for pain and quality of life for TJA.

scholarly journals Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

2020 ◽  
Author(s):  
Jurek Rafal Tomasz Pietrzak ◽  
Zia Maharaj ◽  
Lipalo Mokete
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Staphylococcus Aureus ◽  
Total Joint Arthroplasty ◽  
Population Group ◽  
Developed Countries ◽  
Joint Arthroplasty ◽  
Joint Infections ◽  
Intranasal Mupirocin ◽  
Mupirocin Ointment

Abstract Background: Periprosthetic joint infections (PJIs) are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty (TJA). Staphylococcus aureus (S aureus) colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in S aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of S aureus colonization in patients awaiting TJA in South Africa. Methods: We prospectively assessed 119 patients awaiting Total Knee Arthroplasty and Total Hip Arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for S aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t-tests, Fisher’s exact tests, and chi square analyses. Results: The overall prevalence of Methicillin Sensitive S aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant S aureus. Nasal swabs returned a yield of 81.6% (n=31), with groin swabs and axillary swabs at 39.5% (n=15) and 28.9% (n=11) respectively. Eradication was successful in 94.74% (n=36) after five days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n=9). The 30-day readmission rate in the S aureus -colonized group was 7.9% (n=3) as opposed to 7.4% (n=6) in the non-colonized cohort. There were no 60- and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years. Conclusions: The rate of S aureus colonization in patients undergoing elective TJA in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.

scholarly journals Nasal decolonization of Staphylococcus aureus and the risk of surgical site infection after surgery: a meta-analysis

2020 ◽  
Author(s):  
Jia Tang ◽  
Jiangjin Hui ◽  
Jing Ma ◽  
Mingquan Chen
Keyword(s):  
Staphylococcus Aureus ◽  
Meta Analysis ◽  
Surgical Site Infections ◽  
Cochrane Library ◽  
Antimicrobial Drugs ◽  
Pulmonary Surgery ◽  
Significant Difference ◽  
Different Types ◽  
The Cochrane Library ◽  
Risk Ratios

Abstract Aim: To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are Staphylococcus aureus carriers undergoing different types of surgeries and diverse measures of decolonization. Methods: Relevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries and measures of decolonization that Staphylococcus aureus carriers were applied.Results: Twenty RCTs published between 1996 and 2019 involving 10526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR=0.59 and 0.47, respectively, both p<0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies. As for the diverse measures of nasal decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used different types of antimicrobial drugs, and 5% use others. The SSIs rate were decreased after chlorhexidine (RR=0.474, 95% CI: 0.259-0.864), while no significant difference was shown in the use of mupirocin (RR=0.871, 95% CI: 0.544-1.394).Conclusion: It seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSIs in these patients, especially in patients who have been administered by pulmonary surgeries or treated with chlorhexidine.

scholarly journals Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

2020 ◽  
Author(s):  
Jurek Rafal Tomasz Pietrzak ◽  
Zia Maharaj ◽  
Lipalo Mokete
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Staphylococcus Aureus ◽  
Total Joint Arthroplasty ◽  
Population Group ◽  
Developed Countries ◽  
Joint Arthroplasty ◽  
Joint Infections ◽  
Intranasal Mupirocin ◽  
Mupirocin Ointment

Abstract Background: Periprosthetic joint infections are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty. Staphylococcus aureus colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in Staphylococcus aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of Staphylococcus aureus colonization in patients awaiting Total Joint Arthroplasty in South Africa. Methods: We prospectively assessed 119 patients awaiting Total Knee Arthroplasty and Total Hip Arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for Staphylococcus aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t-tests, Fisher’s exact tests, and chi square analyses. Results: The overall prevalence of Methicillin Sensitive Staphylococcus aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant Staphylococcus aureus . Nasal swabs returned a yield of 81.6%(n=31), with groin swabs and axillary swabs at 39.5% (n=15) and 28.9% (n=11) respectively. Eradication was successful in 94.74% (n=36) after five days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n=9). The 30-day readmission rate in the Staphylococcus aureus -colonized group was 7.9% (n=3) as opposed to 7.4% (n=6) in the non-colonized cohort. There were no 60- and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years. Conclusions: The rate of Staphylococcus aureus colonization in patients undergoing elective Total Joint Arthroplasty in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.

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