Retrospective Validation of Methicillin Resistant Staphylococcus aureus Risk Assessment Tool against Nasal PCR screening in Hip and Knee Replacement surgeries 公开
Thyagarajan, Rama (Fall 2020)
Published
Abstract
Objective: Due to aging population and increasing prevalence of obesity, joint replacement surgeries are projected to increase substantially by 2030. Prosthetic joint infections (PJI) occur in about 2 % of patients undergoing joint replacement and methicillin resistant Staphylococcus aureus (MRSA) is a serious pathogen causing PJI. Skin and nasal colonization is a risk factor for MRSA infections and nasal polymerase chain reaction (PCR) or nasal culture test is used to assess nasal colonization so effective decolonization can be performed. We evaluated a five question patient factor based MRSA risk assessment tool against the nasal PCR methodology.
Methods: Pre-operative orthopedic patients who underwent nasal PCR screening before hip or knee arthroplasty at Beaumont Hospital, Dearborn (BHD) from July 2015 to March 2016 were studied retrospectively. Electronic medical record (EMR) review of demographic information and antibiotic use along with on five patient factors that may predict MRSA colonization was collected. The patient factors studied include diabetes mellitus on insulin, hemodialysis, and hospital stay in the last 90 days before surgery, active hospital stay three days before surgery and prior positive clinical culture or PCR of MRSA in the last year. Multi variable logistic regression was used to assess if patient factors were able to predict MRSA colonization against nasal PCR screening as a gold standard.
Results: A total of 751 patients underwent nasal PCR screening, of which 38 (5.1%) were MRSA PCR positive and 162 (21.6%) were methicillin susceptible Staphylococcus aureus (MSSA) PCR positive. MRSA positive PCR was the dependent variable and the patient risk factors were independent variables. Multivariable logistic regression showed no correlation between patient factors and positive PCR test. The prevalence of risk factors among MRSA positive and MSSA positive patients were similar. Vancomycin use would decrease from 13.7% (with implementation of risk assessment tool) in comparison to PCR screening with only 5.9 % pre operatively receiving Vancomycin in this study.
Conclusions: MRSA risk assessment tool did not co relate well against the nasal PCR test to indicate nasal MRSA colonization.
Table of Contents
Distribution Agreement……………………………………………………………………………I
Approval sheet…………………………………………………………………………………………II
Abstract Cover page…………………………………………………………………………………III
Abstract…………………………………………………………………………………………………..IV
Cover page………………………………………………………………………………………………V
Acknowledgement…………………………………………………………………………………..VI
Chapter I: Introduction…………………………………………………………………………1
Definitions of terms………………………………………………………………..6
Chapter II: Literature review……………………………………………………………………8
Chapter III: Methods……………………………………………………………………………….19
Chapter IV: Results………………………………………………………………………………….24
Chapter V: Discussion…………………………………………………………………………….27
Chapter VI: Conclusion ………………………………………………………………………….34
References……………………………………………………………………………………………..35
Illustrations
Figures
Figure 1…………………………………………………………………………………………………….38
Tables
Table 1………………………………………………………………………………………………………39
Table 2………………………………………………………………………………………………………39
Table 3………………………………………………………………………………………………………40
Table 4………………………………………………………………………………………………………40
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Retrospective Validation of Methicillin Resistant Staphylococcus aureus Risk Assessment Tool against Nasal PCR screening in Hip and Knee Replacement surgeries () | 2020-12-03 09:06:40 -0500 |
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