Abstract
Prosthetic joint infections are responsible for a high morbidity and economic cost in patients undergoing total joint arthroplasty. <i>Staphylococcus aureus</i> (<i>S Aureus</i>) is a key modifiable risk factor in the reduction of surgical site infections (SSI). Evidence suggests that decolonization of <i>S aureus</i> carriers reduces the risk of SSI. Octenidine is an antiseptic active against gram-positive and gram-negative bacteria. The aim of this study is to establish the eradication rate of <i>S aureus</i> in patients undergoing total joint arthroplasty using an Octenidine decolonisation protocol prior to surgery. This was a prospective case series performed at the Cairns Private Hospital during a five month trial period of using Octenidine wash and nasal gel in patients undergoing elective TJA. Patients undergoing total joint arthroplasty during a five-month trial period had pre-operative nasal swabs to screen for S aureus pre and post Octenidine treatment. All patients underwent a body wash and nasal gel protocol for five days using Octenidine. The primary outcome was to determine decolonisation rates in patients following the protocol. A total of 183 patients met inclusion criteria into this study. At the first swab 151 (82.5%) patients had normal regional flora and 32 (17.5%) were positive for S aureus. Of these 32 patients 30 (93.75%) were negative for MRSA and 2 (6.25%) had non-multiresistant MRSA. The decolonization rate for patients with S aureus was 76.6%. It was unsuccessful in clearing the two patients with nmMRSA. Octenidine is effective in reducing <i>S aureus</i> colonisation in patients undergoing total joint arthroplasty. Further studies are required to compare this agent to traditional mupirocin based protocols to determine its efficacy as an alternative for use in pre-operative staphylococcal decolonisation.
Highlights
Prosthetic joint infection is a devastating complication for patients to suffer and it carries considerable social and economic cost
Several studies have been conducted on nasal decolonisation of patients undergoing orthopedic surgery by using perioperative intranasal mupirocin. [2,3,4] Intranasal mupirocin and chlorhexidine wash is the gold standard antimicrobial for decolonization of S aureus and has been shown to eradication rates between 81.5 - 100% following a course of treatment. [5, 6] This is an attractive prevention strategy being a safe and simple method to eradicate nasal colonization
This study has shown that an Octenidine decolonisation protocol prior to surgery is successful in eradicating S aureus carriage in elective total joint arthroplasty patients in 71.8% of cases
Summary
Prosthetic joint infection is a devastating complication for patients to suffer and it carries considerable social and economic cost. Modifiable risk factors are increasingly being identified to optimise patient outcomes. Staphylococcus aureus colonisation has been recognised as a key modifiable risk factor for surgical site infections (SSI) in patients who are undergoing elective total joint arthroplasty (TJA). Patients undergoing TJA are typically treated under a “screen and treat” protocol. This protocol involves patients being screened at a pre-admission clinic for S aureus and if tested positive undergoing a decolonisation protocol prior to surgery. Several studies have been conducted on nasal decolonisation of patients undergoing orthopedic surgery by using perioperative intranasal mupirocin. [2,3,4] Intranasal mupirocin and chlorhexidine wash is the gold standard antimicrobial for decolonization of S aureus and has been shown to eradication rates between 81.5 - 100% following a course of treatment.
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