Impact of preoperative decolonization for Staphylococcus aureus in patients undergoing spine surgery and total arthroplasties at the Institute of Orthopedics and Traumatology, Hospital das Clínicas FMUSP

• Grant number: 23/12620-5
• Support Opportunities: Regular Research Grants
• Duration: February 01, 2024 - January 31, 2026
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Ana Lucia Lei Munhoz Lima
• Grantee: Ana Lucia Lei Munhoz Lima
• Host Institution: Instituto de Ortopedia e Traumatologia Professor Francisco Elias de Godoy Moreira (IOT). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated researchers: Angélica Makio dos Anjos ; Priscila Rosalba Domingos de Oliveira ; Vanessa Ferreira Amorim de Melo ; Vladimir Cordeiro de Carvalho
• Associated scholarship(s): 24/03387-8 - Impact of preoperative decolonization for Staphylococcus aureus in patients undergoing spine surgery and total arthroplasty at the Institute of Orthopedics and Traumatology of Hospital das Clínicas FMUSP, BP.TT

Abstract

Staphylococcus aureus (S. aureus) is the most common agent when it comes to surgical site infection (SSI), and about 15 to 32% of the world's population is colonized by methicillin-sensitive S. aureus (MSSA) and 1 to 3% colonized by methicillin-resistant S. aureus (MRSA) 2. This colonization occurs mainly in the nostrils in about one in four people, increasing the risk of SSI by 2 to 14 times 1. Approximately 80% of the strains that cause infection originate from endogenous and are genetically similar to strains isolated from nasal swabs 5. For more complex orthopedic surgeries, nasal colonization by Staphylococcus aureus may increase the risk of SSI, making its prevention an important measure to combat postoperative infection. In this context, nasal decolonization of such patients to reduce the biological burden of MRSA/MSSA has been shown to reduce the rate of periprosthetic infection, but the evidence is limited. Therefore, this study aims to contribute mainly to the Brazilian scenario, evaluating the impact of S. aureus decolonization with 2% intranasal mupirocin and 2% chlorhexidine degermant in patients undergoing clean and primary spine surgery, total hip arthroplasty, total hip arthroplasty knee and shoulder arthroplasty, on rates of surgical site infection related to these procedures. Methodology: This is a longitudinal and prospective study in a series of cases of patients who will undergo clean and elective spine surgeries with the presence of synthesis and total arthroplasties who will undergo preoperative decolonization for S. aureus. Patients will be evaluated for the presence of MRSA, MSSA, and healthcare-related SSI. In order to compare the SSI incidence, a retrospective analysis of the procedures studied in the period before the preoperative decolonization protocol was instituted will be carried out. (AU)