Low risk despite high endemicity of methicillin-resistant Staphylococcus aureus infections following elective total joint arthroplasty: a 12-year experience.
Uçkay I., Lübbeke A., Harbarth S., Emonet S., Tovmirzaeva L., Agostinho A., Longtin Y., Peter R., Hoffmeyer P., Pittet D.
Abstract Background. It is unknown if low rates of arthroplasty infections due to methicillin-resistant Staphylococcus aureus (MRSA) can be achieved in a setting with endemic MRSA (30%). Methods. We performed a 12-year prospective cohort study (1996-2008) of patients undergoing elective knee and hip joint arthroplasties with long-term follow-up. Retrospective MRSA surveillance was undertaken using electronic databases. Results. A total of 6,100 total joint arthroplasties (4001 hip; 2099 knee; 441 (7%) revisions) were monitored for a total of 34,281 person-years of follow-up (median 64 months). MRSA carriage was detected in 126 (2.1%) episodes before arthroplasty and in 147 (2.4%) after arthroplasty. Seven (0.11%) deep arthroplasty infections due to MRSA were retrieved for an overall incidence of 2 episodes per 10,000 person-years. Six were primary surgical site infections, while one infection resulted from endocarditis. MRSA colonization pressure was 11,411 MRSA-positive days for a total of 138,044 patient-days (8.3%) among all orthopedic patients. Conclusion. Institution-wide MRSA endemicity does not necessarily lead to a high MRSA infection risk after elective hip and knee arthroplasty.