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      Staphylococcus aureus colonization and periprosthetic joint infection in patients undergoing elective total joint arthroplasty: a narrative review

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          Abstract

          • Peri-prosthetic joint infections (PJIs) following total joint arthroplasty (TJA) are associated with higher treatment costs, longer hospital admissions and increased morbidity and mortality.

          • Colonization with Staphylococcus aureus is an independent and modifiable risk factor for PJIs and carriers of S. aureus are ten times more likely than non-carriers for post-operative infections.

          • Screening and targeted decolonization, vs universal decolonization without screening, remains a controversial topic.

          • We recommend a tailored approach, based on local epidemiological patterns, resource availability and logistical capacity.

          • Universal decolonization is associated with lower rates of SSI and may reduce treatment costs.

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          Most cited references87

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          Human commensals producing a novel antibiotic impair pathogen colonization.

          Alexander Zipperer, Martin Konnerth, Claudia Laux … (2016)
          The vast majority of systemic bacterial infections are caused by facultative, often antibiotic-resistant, pathogens colonizing human body surfaces. Nasal carriage of Staphylococcus aureus predisposes to invasive infection, but the mechanisms that permit or interfere with pathogen colonization are largely unknown. Whereas soil microbes are known to compete by production of antibiotics, such processes have rarely been reported for human microbiota. We show that nasal Staphylococcus lugdunensis strains produce lugdunin, a novel thiazolidine-containing cyclic peptide antibiotic that prohibits colonization by S. aureus, and a rare example of a non-ribosomally synthesized bioactive compound from human-associated bacteria. Lugdunin is bactericidal against major pathogens, effective in animal models, and not prone to causing development of resistance in S. aureus. Notably, human nasal colonization by S. lugdunensis was associated with a significantly reduced S. aureus carriage rate, suggesting that lugdunin or lugdunin-producing commensal bacteria could be valuable for preventing staphylococcal infections. Moreover, human microbiota should be considered as a source for new antibiotics.
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            Health care-associated infections – an overview

            Mainul Haque, Massimo Sartelli, Judy McKimm … (2018)
            Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. Multiple studies indicate that the common types of adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications. The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one in 17) die due to these. Several studies suggest that simple infection-control procedures such as cleaning hands with an alcohol-based hand rub can help prevent HCAIs and save lives, reduce morbidity, and minimize health care costs. Routine educational interventions for health care professionals can help change their hand-washing practices to prevent the spread of infection. In support of this, the WHO has produced guidelines to promote hand-washing practices among member countries.
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              Periprosthetic joint infection.

              Bhaveen H Kapadia, Richard A Berg, Jacqueline Daley … (2016)
              Periprosthetic joint infections are a devastating complication after arthroplasty and are associated with substantial patient morbidity. More than 25% of revisions are attributed to these infections, which are expected to increase. The increased prevalence of obesity, diabetes, and other comorbidities are some of the reasons for this increase. Recognition of the challenge of surgical site infections in general, and periprosthetic joint infections particularly, has prompted implementation of enhanced prevention measures preoperatively (glycaemic control, skin decontamination, decolonisation, etc), intraoperatively (ultraclean operative environment, blood conservation, etc), and postoperatively (refined anticoagulation, improved wound dressings, etc). Additionally, indications for surgical management have been refined. In this Review, we assess risk factors, preventive measures, diagnoses, clinical features, and treatment options for prosthetic joint infection. An international consensus meeting about such infections identified the best practices and further research needs. Orthopaedics could benefit from enhanced preventive, diagnostic, and treatment methods.
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                Author and article information

                Journal
                Journal ID (nlm-ta): EFORT Open Rev
                Journal ID (iso-abbrev): EFORT Open Rev
                Journal ID (publisher-id): eor
                Title: EFORT Open Reviews
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2058-5241
                Publication date (Electronic): 01 September 2023
                Publication date Collection: 01 September 2023
                Volume: 8
                Issue: 9
                Pages: 680-689
                Affiliations
                [1 ]Orthopaedic Surgery , University of Witswatersrand, Johannesburg, South Africa
                [2 ]Emergency Department , ER Consulting, Johannesburg, South Africa
                [3 ]Department Orthopaedic Surgery , Life Fourways Hospital, Johannesburg, South Africa
                Author notes
                Correspondence should be addressed to M de Buys; Email: debuysm@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-8780-433X
                Article
                Publisher ID: EOR-23-0031
                DOI: 10.1530/EOR-23-0031
                PMC ID: 10548302
                PubMed ID: 37655845
                SO-VID: 251ea9bf-0449-4edf-9550-e9f604144103
                Copyright © © the author(s)
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Categories
                Subject: General Orthopaedics
                Compound subject: general-orthopaedics, General Orthopaedics
                Subject: Arthroplasty
                Subject: Staphylococcus
                Subject: Infection
                Subject: Staphylococcus Aureus
                Subject: Pji
                Subject: Colonization
                Subject: Eradication
                Custom metadata
                ifp:collection general-orthopaedics

                Keywords: arthroplasty,staphylococcus,infection,staphylococcus aureus,pji,colonization,eradication
                Data availability:
                Keywords: arthroplasty, staphylococcus, infection, staphylococcus aureus, pji, colonization, eradication

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