Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus? A part-retrospective case–control study in a Scottish hospital
Identifieur interne : 003B07 ( Ncbi/Checkpoint ); précédent : 003B06; suivant : 003B08Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus? A part-retrospective case–control study in a Scottish hospital
Auteurs : Stephanie J. Dancer [Royaume-Uni] ; Fraser Christison [Royaume-Uni] ; Attaolah Eslami [Royaume-Uni] ; Alberto Gregori [Royaume-Uni] ; Roslyn Miller [Royaume-Uni] ; Kumar Perisamy [Royaume-Uni] ; Chris Robertson [Royaume-Uni, France] ; Nick Graves [Australie]Source :
- BMJ Open [ 2044-6055 ] ; 2016.
Abstract
With recent focus on methicillin-resistant
We broadened MRSA screening to include MSSA for elective orthopaedic patients. Preoperative decolonisation was offered if appropriate. Elective and trauma patients were audited for staphylococcal infection during 2 6-month periods (A: January to June 2013 MRSA screening; B: January to June 2014 MRSA and MSSA screening). Trauma patients are not screened presurgery and provided a control. MSSA screening costs of a modelled cohort of 500 elective patients were offset by changes in number and costs of MSSA infections to demonstrate the change in total health service costs.
Trauma patients showed similar infection rates during both periods (p=1). In period A, 4 (1.72%) and 15 (6.47%) of 232 elective patients suffered superficial and deep MSSA infections, respectively, with 6 superficial (2%) and 1 deep (0.3%) infection among 307 elective patients during period B. For any MSSA infection, risk ratios were 0.95 (95% CI 0.41 to 2.23) for trauma and 0.28 (95% CI 0.12 to 0.65) for elective patients (period B vs period A). For deep MSSA infections, risk ratios were 0.58 (95% CI 0.20 to 1.67) for trauma and 0.05 (95% CI 0.01 to 0.36) for elective patients (p=0.011). There were 29.12 fewer deep infections in the modelled cohort of 500 patients, with a cost reduction of £831 678 for 500 patients screened.
MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits.
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DOI: 10.1136/bmjopen-2016-011642
PubMed: 27601492
PubMed Central: 5020861
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Dancer</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Microbiology</addr-line>,<institution>Hairmyres Hospital, NHS Lanarkshire</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Christison, Fraser" sort="Christison, Fraser" uniqKey="Christison F" first="Fraser" last="Christison">Fraser Christison</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Microbiology</addr-line>,<institution>Hairmyres Hospital, NHS Lanarkshire</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Eslami, Attaolah" sort="Eslami, Attaolah" uniqKey="Eslami A" first="Attaolah" last="Eslami">Attaolah 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uniqKey="Graves N" first="Nick" last="Graves">Nick Graves</name><affiliation wicri:level="1"><nlm:aff id="af6"><institution>Institute of Health & Biomedical Innovation, Queensland University of Technology</institution>,<addr-line>Brisbane, Queensland</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27601492</idno><idno type="pmc">5020861</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020861</idno><idno type="RBID">PMC:5020861</idno><idno type="doi">10.1136/bmjopen-2016-011642</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002315</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002315</idno><idno type="wicri:Area/Pmc/Curation">002165</idno><idno type="wicri:explorRef" wicri:stream="Pmc" 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aureus</italic>? A part-retrospective case–control study in a Scottish hospital</title><author><name sortKey="Dancer, Stephanie J" sort="Dancer, Stephanie J" uniqKey="Dancer S" first="Stephanie J" last="Dancer">Stephanie J. Dancer</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Microbiology</addr-line>,<institution>Hairmyres Hospital, NHS Lanarkshire</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Christison, Fraser" sort="Christison, Fraser" uniqKey="Christison F" first="Fraser" last="Christison">Fraser Christison</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Microbiology</addr-line>,<institution>Hairmyres Hospital, NHS Lanarkshire</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Eslami, Attaolah" sort="Eslami, Attaolah" uniqKey="Eslami A" first="Attaolah" last="Eslami">Attaolah Eslami</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Orthopaedics</addr-line>,<institution>Hairmyres Hospital, NHS Lanarkshire</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Gregori, Alberto" sort="Gregori, Alberto" uniqKey="Gregori A" first="Alberto" last="Gregori">Alberto Gregori</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Orthopaedics</addr-line>,<institution>Hairmyres Hospital, NHS Lanarkshire</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Miller, Roslyn" sort="Miller, Roslyn" uniqKey="Miller R" first="Roslyn" last="Miller">Roslyn Miller</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Orthopaedics</addr-line>,<institution>Hairmyres Hospital, NHS Lanarkshire</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Perisamy, Kumar" sort="Perisamy, Kumar" uniqKey="Perisamy K" first="Kumar" last="Perisamy">Kumar Perisamy</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Orthopaedics</addr-line>,<institution>Hairmyres Hospital, NHS Lanarkshire</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Robertson, Chris" sort="Robertson, Chris" uniqKey="Robertson C" first="Chris" last="Robertson">Chris Robertson</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Department of Mathematics and Statistics</addr-line>,<institution>University of Strathclyde</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af4"><institution>Health Protection Scotland</institution>,<addr-line>Glasgow</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af5"><institution>International Prevention Research Institute</institution>,<addr-line>Lyon</addr-line>,<country>France</country></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Graves, Nick" sort="Graves, Nick" uniqKey="Graves N" first="Nick" last="Graves">Nick Graves</name><affiliation wicri:level="1"><nlm:aff id="af6"><institution>Institute of Health & Biomedical Innovation, Queensland University of Technology</institution>,<addr-line>Brisbane, Queensland</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>With recent focus on methicillin-resistant <italic>Staphylococcus aureus</italic> (MRSA) screening, methicillin-susceptible <italic>S. aureus</italic> (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery.</p></sec><sec><title>Methods</title><p>We broadened MRSA screening to include MSSA for elective orthopaedic patients. Preoperative decolonisation was offered if appropriate. Elective and trauma patients were audited for staphylococcal infection during 2 6-month periods (A: January to June 2013 MRSA screening; B: January to June 2014 MRSA and MSSA screening). Trauma patients are not screened presurgery and provided a control. MSSA screening costs of a modelled cohort of 500 elective patients were offset by changes in number and costs of MSSA infections to demonstrate the change in total health service costs.</p></sec><sec><title>Findings</title><p>Trauma patients showed similar infection rates during both periods (p=1). In period A, 4 (1.72%) and 15 (6.47%) of 232 elective patients suffered superficial and deep MSSA infections, respectively, with 6 superficial (2%) and 1 deep (0.3%) infection among 307 elective patients during period B. For any MSSA infection, risk ratios were 0.95 (95% CI 0.41 to 2.23) for trauma and 0.28 (95% CI 0.12 to 0.65) for elective patients (period B vs period A). For deep MSSA infections, risk ratios were 0.58 (95% CI 0.20 to 1.67) for trauma and 0.05 (95% CI 0.01 to 0.36) for elective patients (p=0.011). There were 29.12 fewer deep infections in the modelled cohort of 500 patients, with a cost reduction of £831 678 for 500 patients screened.</p></sec><sec><title>Conclusions</title><p>MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Kluytmans, J" uniqKey="Kluytmans J">J Kluytmans</name></author><author><name sortKey="Van Belkum, A" uniqKey="Van Belkum A">A Van Belkum</name></author><author><name sortKey="Verbrugh, H" uniqKey="Verbrugh H">H Verbrugh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Von Eiff, C" uniqKey="Von Eiff C">C von Eiff</name></author><author><name sortKey="Becker, K" uniqKey="Becker K">K Becker</name></author><author><name sortKey="Machka, K" uniqKey="Machka K">K Machka</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kalmeijer, Md" uniqKey="Kalmeijer M">MD Kalmeijer</name></author><author><name sortKey="Van Nieuwland Bollen, E" uniqKey="Van Nieuwland Bollen E">E van Nieuwland-Bollen</name></author><author><name sortKey="Bogaers Hofman, D" uniqKey="Bogaers Hofman D">D Bogaers-Hofman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bandyk, Df" uniqKey="Bandyk D">DF Bandyk</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reilly, Js" uniqKey="Reilly J">JS Reilly</name></author><author><name sortKey="Stewart, S" uniqKey="Stewart S">S Stewart</name></author><author><name sortKey="Christie, P" uniqKey="Christie P">P Christie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Anderson, Dj" uniqKey="Anderson D">DJ Anderson</name></author><author><name sortKey="Podgorny, K" uniqKey="Podgorny K">K Podgorny</name></author><author><name sortKey="Berrios Torres, Si" uniqKey="Berrios Torres S">SI Berríos-Torres</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stone, Sp" uniqKey="Stone S">SP Stone</name></author><author><name sortKey="Fuller, C" uniqKey="Fuller C">C Fuller</name></author><author><name sortKey="Savage, J" uniqKey="Savage J">J Savage</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Merollini, Kmd" uniqKey="Merollini K">KMD Merollini</name></author><author><name sortKey="Crawford, Rw" uniqKey="Crawford R">RW Crawford</name></author><author><name sortKey="Graves, N" uniqKey="Graves N">N Graves</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kallala, Rf" uniqKey="Kallala R">RF Kallala</name></author><author><name sortKey="Vanhegan, Is" uniqKey="Vanhegan I">IS Vanhegan</name></author><author><name sortKey="Ibrahim, Ms" uniqKey="Ibrahim M">MS Ibrahim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Af" uniqKey="Chen A">AF Chen</name></author><author><name sortKey="Wessel, Cb" uniqKey="Wessel C">CB Wessel</name></author><author><name sortKey="Rao, N" uniqKey="Rao N">N Rao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wassenberg, Mw" uniqKey="Wassenberg M">MW Wassenberg</name></author><author><name sortKey="De Wit, Ga" uniqKey="De Wit G">GA de Wit</name></author><author><name sortKey="Bonten, Mj" uniqKey="Bonten M">MJ Bonten</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bebko, Sp" uniqKey="Bebko S">SP Bebko</name></author><author><name sortKey="Byers, P" uniqKey="Byers P">P Byers</name></author><author><name sortKey="Green, Dm" uniqKey="Green D">DM Green</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Edgeworth, Jd" uniqKey="Edgeworth J">JD Edgeworth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mitchell, Bg" uniqKey="Mitchell B">BG Mitchell</name></author><author><name sortKey="Collignon, Pj" uniqKey="Collignon P">PJ Collignon</name></author><author><name sortKey="Mccann, R" uniqKey="Mccann R">R McCann</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Royaume-Uni</li></country></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Dancer, Stephanie J" sort="Dancer, Stephanie J" uniqKey="Dancer S" first="Stephanie J" last="Dancer">Stephanie J. Dancer</name></noRegion><name sortKey="Christison, Fraser" sort="Christison, Fraser" uniqKey="Christison F" first="Fraser" last="Christison">Fraser Christison</name><name sortKey="Eslami, Attaolah" sort="Eslami, Attaolah" uniqKey="Eslami A" first="Attaolah" last="Eslami">Attaolah Eslami</name><name sortKey="Gregori, Alberto" sort="Gregori, Alberto" uniqKey="Gregori A" first="Alberto" last="Gregori">Alberto Gregori</name><name sortKey="Miller, Roslyn" sort="Miller, Roslyn" uniqKey="Miller R" first="Roslyn" last="Miller">Roslyn Miller</name><name sortKey="Perisamy, Kumar" sort="Perisamy, Kumar" uniqKey="Perisamy K" first="Kumar" last="Perisamy">Kumar Perisamy</name><name sortKey="Robertson, Chris" sort="Robertson, Chris" uniqKey="Robertson C" first="Chris" last="Robertson">Chris Robertson</name><name sortKey="Robertson, Chris" sort="Robertson, Chris" uniqKey="Robertson C" first="Chris" last="Robertson">Chris Robertson</name></country><country name="France"><noRegion><name sortKey="Robertson, Chris" sort="Robertson, Chris" uniqKey="Robertson C" first="Chris" last="Robertson">Chris Robertson</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Graves, Nick" sort="Graves, Nick" uniqKey="Graves N" first="Nick" last="Graves">Nick Graves</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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