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Master Thesis

Intérêt du dépistage du Staphylococcus aureus et de la décolonisation préopératoire par Mupirocine et Chlorhexidine sur le risque d’infections du site opératoire en chirurgie orthopédique : une étude avant-après

Abstract : Background. Staphylococcus aureus nasal colonization is a risk factor of surgical site infection (SSI) in orthopedic surgery, but the S. aureus screening and decolonization efficacy in reducing the risk of SSI is uncertain in this specialty. The objectives of this study were to evaluate the impact of implementing a screening and targeted decolonization strategy on the risk of single-microbial S. aureus SSIs (primary objective), SSIs related to commensal skin flora and SSis with all microorganisms combined, in orthopedic surgery. The risk factors associated with the occurrence S. aureus SSIs were also analyzed. Methods. A retrospective before-and-after and here-and-now study performed between January 2014 and June 2020 in one orthopedic surgery department that implemented the strategy (historical control group and intervention group) and one that did not (control group). Mupirocine and Chlorhexidine decolonization was performed in patients screened and colonized with S. aureus, starting in February 2017 in only 1 of the 2 orthopedic departments. Patients were followed for 1 year to identify potential SSI. Included surgeries were scheduled hip and knee replacements and osteosynthesis surgeries, in adult patients. Results. A total of 2305 surgeries were included in the intervention group (over the period 2017 – 2020), 1926 in the historical control group (over the period 2014 - 2017) and 1117 in the control group (over the period 2014 – 2020). A downward trend but non-significant in SSI rates for S. aureus (0.3% vs 0.5%), commensal skin flora (0.4% vs 0.6%), and an inscreasning trend but non-significant in overall SSI rate (1.2% vs 0.9%) were observed in the group where the S. aureus screening and decolonization strategy was implemented compared to the historical control group. After multivariate analysis includibg the 3 study groups, the independent risk factors for monomicrobial S. aureus SSIs were body mass index (BMI, adjested OR (Ora)per unit BMI, 1.05; 95% CI, 1.0-1.1), Charlson comorbidity index (ORaper index point, 1.34; 95% CI, 1.0-1.8), and duration of the surgery (ORaper minute, 1.01; 95% CI, 1.00-1.02). The presence of preoperative S. aureus screening was a protective factor (ORa, 0.24; 95% CI, 0.08-0.73). Conclusion. There was no significant difference in the number of S. aureus SSI rate between the intervention group and the historical control group. However, screening and decolonization of S. aureus colonized patients appears to be a significant protective factor for the risk of S. aureus SSI, after adjustment for other risk factors. Randomized controlled trials are needed to confirm these results.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03663340
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Wednesday, May 11, 2022 - 3:19:56 PM
Last modification on : Thursday, May 12, 2022 - 3:46:45 AM

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  • HAL Id : dumas-03663340, version 1

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Antoine Portais. Intérêt du dépistage du Staphylococcus aureus et de la décolonisation préopératoire par Mupirocine et Chlorhexidine sur le risque d’infections du site opératoire en chirurgie orthopédique : une étude avant-après. Médecine humaine et pathologie. 2022. ⟨dumas-03663340⟩

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