Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2021; 12(11): 842-849
Published online Nov 18, 2021. doi: 10.5312/wjo.v12.i11.842
Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy
Benjamin Pal Kapur, Xenia Tonge, Gunasekaran Kumar
Benjamin Pal Kapur, Xenia Tonge, Gunasekaran Kumar, Trauma and Orthopaedics, Royal Liverpool University Teaching Hospitals, Liverpool L7 8XP, Merseyside, United Kingdom
Author contributions: Kapur BP, Tonge X and Kumar G contributed equally to this work.
Institutional review board statement: No ethics approval was required for this retrospective review. This study was registered with the hospitals audit department.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
Data sharing statement: Data is available if requested from the corresponding author at benjaminkapur@nhs.net.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Benjamin Pal Kapur, FRCS, MBChB, Surgeon, Trauma and Orthopaedics, Royal Liverpool University Teaching Hospitals, Prescott Street, Liverpool L7 8XP, Merseyside, United Kingdom. benjaminkapur@nhs.net
Received: May 12, 2021
Peer-review started: May 12, 2021
First decision: July 28, 2021
Revised: August 8, 2021
Accepted: September 29, 2021
Article in press: September 29, 2021
Published online: November 18, 2021
Processing time: 187 Days and 14.1 Hours
ARTICLE HIGHLIGHTS
Research background

Difference in screening between two hospital trust which were merging.

Research motivation

Developing a uniform policy for screening and managing methicillin-resistant staphylococcus aureus (MRSA) prosthetic joint infection (PJI).

Research objectives

Eradication therapy is not universally effective. The reasons for this are multifactorial including dose strength and compliance.

Research methods

All patients who underwent total hip and knee arthroplasty between December 2009 and December 2019 were identified. Patients who were also identified as positive for MRSA in the preoperative evaluation. After recording the confirmation of the eradication treatment prescription, all the processes were reviewed retrospectively. The results of each MRSA-positive patient were compared with the results of two MRSA-negative patients who had the same consultant, were of the same age, and had the same surgery.

Research results

Screening identified 42 knee and 32 hip arthroplasty patients as MRSA positive, 84 MRSA negative knee and 64 hip patients were reviewed. Patients were matched with medical co-morbidities in each group. Mean follow up was 5 years. PJI was identified in 4/32 (12.5%) of total hip replacements MRSA positive and 3/42 (7%) of total knee replacements patients. All patients had PJI within one year of surgery.

Research conclusions

MRSA positive patients are given eradication therapy routinely. However, no confirmation of eradication is sought. Patients who have MRSA colonisation pre-operatively, in our study had a significantly increased risk of PJI, when compared to negative patients. We would recommend establishing true eradication after treatment prior to arthroplasty.

Research perspectives

Further research needs to be performed into eradication therapy and strategy and also for those patients who do not respond to eradication therapy.