Preoperative Staphylococcus aureus nasal screening and decolonization for the prevention of periprosthetic joint infection in elective total joint arthroplasty: A single-center retrospective comparative study.

INTRODUCTION

Staphylococcus aureus is the most frequently implicated pathogen in periprosthetic joint infections (PJIs) and surgical site infections (SSIs), with nasal colonization being a well-established risk factor for their onset. Despite this association, the role of routine preoperative screening and decolonization in reducing postoperative infection rates remains debated.

METHODS

This retrospective study analyzed 2,507 elective joint arthroplasty procedures performed between January 2022 and December 2024 at a single center in Italy. Starting in 2024, patients underwent nasal swab screening for methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA). Positive carriers received a decolonization protocol consisting of mupirocin nasal ointment and chlorhexidine showers in the days preceding surgery. The incidence of PJIs in this group was compared to that observed in a control cohort from 2022-2023, during which no screening or decolonization was implemented.

RESULTS

Among the 988 patients screened in 2024, 231 (25.2%) tested positive for MSSA and 18 (1.8%) for MRSA. Notably, no PJIs caused by MSSA or MRSA were reported that year, compared to three such cases recorded in the preceding 2 years. Overall, 11 PJIs (0.44%) were documented across the study period. All infections in 2024 occurred in patients who had tested negative for S. aureus colonization. However, the reduction in infection rates did not reach statistical significance (p = 1.00).

CONCLUSIONS

Although the observed decrease in S. aureus-related periprosthetic joint infections was not statistically significant, the trend suggests that preoperative screening and targeted decolonization may contribute to a lower incidence of these infections. These findings support further investigation into standardized preventive strategies to enhance outcomes in joint replacement surgery.