Surgical site infection due to S. aureus is one of the most important complications after hip and knee arthroplasty. Precautions that can be taken before surgery are very important to reduce the incidence of this infection. Aseptic surgical setting and antibiotic prophylaxis reduce the risk of infection, but there is a tendency for this complication to increase worldwide. The increase in the annual number of arthroplasty increases the amount of infection at the same time, which increases the social and economic burden
12,13.
It has been shown in clinical series that nasal S. aureus carriers have increased risk of infection and that nasal carriage is an important way of endogenous contamination 8,14. The relation between S. aureus carriage and increased orthopedic SSI has also been shown in many studies 15-19. It is known that nasal S. aureus carriage may differ in patients living in different geographical regions 5. We prospectively assessed the association between nasal S. aureus carriage and SSI in our cases. Nasal S. aureus carriage was detected in 13.1% of our cases. This ratio varies between 20% and 40% in the literature 5. Surgical site infection associated with nasal carriage was detected in 3 (4.9%) of our cases.
Nasal flora is a source for S. aureus. The interaction between mucin carbonhydrates and staphylococcal proteins provides a suitable environment for colonization of these bacteria on the mucin surface 20. Although preoperative nasal mupirocin ointment has been shown to reduce the risk of S. aureus related SSI in some studies 21-24, this procedure has been found to be ineffective in other studies 25,26. Recent studies have shown that rinsing the nose with disinfectants and administering nasal mupirocin ointment is a combination that reduces MRSA-associated infection risk 27,28. We did not use prophylactic nasal antibiotics and antiseptic administration in our patients. This is the limitation of our study. The wider series comparing decolonized and non-decolonized groups will be the next step in our work.
A definitive preoperative diagnosis of periprosthetic infections is necessary for proper treatment and follow-up, but this is a difficult process. Culture can be affected from many factors such as antibiotic use, biofilm formation, inability to provide the environment to produce rare organisms, and contamination 29-32. Serological tests, including ESR and CRP, can be used in the preoperative evaluation of PJI, but their low specificities reduce their diagnostic value 29,33,34. Many combinations of methods have been used for the diagnosis of PJI 31,32,35-38. The most commonly used diagnostic criteria are purulent discharge or presence of sinus tract, serology, positive culture and histological analysis 29,31,35,36. When we evaluated our cases in terms of periprosthetic infection, we used the criteria defined by Parvizi et al. 4.
There are many studies demonstrating that prolonged surgical procedure, diabetes mellitus and rheumatoid arthritis, ASA grade and BMI increase the risk of infection in orthopedic surgeries and other surgical interventions 35,39. However, in our study, no significant relationship was found between aforementioned parameters and periprosthetic infection. The most important reason for this is the fact that the number of our patients is not sufficient to assess this relationship.
Although there are many limitations of our study, we believe that it is a pioneering study in the evaluation of the relationship between nasal S. aureus carriage and periprosthetic infection in our geographical location and in the patient population we serve.
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