Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus?: a part-retrospective case-control study in a Scottish hospital

Stephanie J Dancer, Fraser Christison, Attaolah Eslami, Alberto Gregori, Roslyn Miller, Kumar Perisamy, Chris Robertson, Nick Graves

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: With recent focus on methicillin-resistant Staphylococcus aureus (MRSA) screening, methicillin-susceptible S. aureus (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery. METHODS: 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. FINDINGS: 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. CONCLUSIONS: MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits.

LanguageEnglish
Article numbere011642
Pages1-7
Number of pages8
JournalBMJ Open
Volume6
Issue number9
DOIs
Publication statusPublished - 6 Sep 2016

Fingerprint

Methicillin
Orthopedics
Staphylococcus aureus
Case-Control Studies
Infection
Methicillin-Resistant Staphylococcus aureus
Wounds and Injuries
Costs and Cost Analysis
Odds Ratio
Staphylococcal Infections
Health Care Costs
Health Services
Cost-Benefit Analysis

Keywords

  • staphylococcus aureus
  • economic evaluation
  • health services research
  • healthcare-acquired infection
  • orthopaedic surgery
  • screening

Cite this

Dancer, Stephanie J ; Christison, Fraser ; Eslami, Attaolah ; Gregori, Alberto ; Miller, Roslyn ; Perisamy, Kumar ; Robertson, Chris ; Graves, Nick. / Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus? a part-retrospective case-control study in a Scottish hospital. In: BMJ Open. 2016 ; Vol. 6, No. 9. pp. 1-7.
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abstract = "BACKGROUND: With recent focus on methicillin-resistant Staphylococcus aureus (MRSA) screening, methicillin-susceptible S. aureus (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery. METHODS: 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. FINDINGS: 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. CONCLUSIONS: MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits.",
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Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus? a part-retrospective case-control study in a Scottish hospital. / Dancer, Stephanie J; Christison, Fraser; Eslami, Attaolah; Gregori, Alberto; Miller, Roslyn; Perisamy, Kumar; Robertson, Chris; Graves, Nick.

In: BMJ Open, Vol. 6, No. 9, e011642, 06.09.2016, p. 1-7.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus?

T2 - BMJ Open

AU - Dancer, Stephanie J

AU - Christison, Fraser

AU - Eslami, Attaolah

AU - Gregori, Alberto

AU - Miller, Roslyn

AU - Perisamy, Kumar

AU - Robertson, Chris

AU - Graves, Nick

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016/9/6

Y1 - 2016/9/6

N2 - BACKGROUND: With recent focus on methicillin-resistant Staphylococcus aureus (MRSA) screening, methicillin-susceptible S. aureus (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery. METHODS: 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. FINDINGS: 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. CONCLUSIONS: MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits.

AB - BACKGROUND: With recent focus on methicillin-resistant Staphylococcus aureus (MRSA) screening, methicillin-susceptible S. aureus (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery. METHODS: 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. FINDINGS: 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. CONCLUSIONS: MSSA screening for elective orthopaedic patients may reduce the risk of deep postoperative MSSA infection with associated cost-benefits.

KW - staphylococcus aureus

KW - economic evaluation

KW - health services research

KW - healthcare-acquired infection

KW - orthopaedic surgery

KW - screening

U2 - 10.1136/bmjopen-2016-011642

DO - 10.1136/bmjopen-2016-011642

M3 - Article

VL - 6

SP - 1

EP - 7

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 9

M1 - e011642

ER -