Staphylococcus aureus Colonization in Patients Undergoing Total Hip or Knee Arthroplasty and Costeffectiveness of Decolonization Programme



1 Orthopedic Department, Arak university of medical sciences, Arak, Iran

2 Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of medical sciences, Tehran, Iran

3 Department of Microbiology and Immunology, Arak University of Medical Sciences, Arak, Iran

4 Orthopedic Surgery, Valiasr Hospital, Arak University of Medical Sciences


Background: Periprosthetic joint infection is a devastating complication of total joint arthroplasty. It seems that the
patient’s skin, nose, throat, and urine are important sites for microbial colonization. Colonization with staphylococcus
aureus, especially methicillin resistant increases the risk of periprosthetic joint infection. The aim of this study was to
assess the prevalence of staphylococcus aureus colonization in patients candidate for arthroplasty in central Iran as
well as cost-effectiveness of decolonization program for prevention of post-arthroplasty infection.
Methods: A total of 226 patient candidates for total joint arthroplasty were enrolled in this prospective cross-sectional
study between January 2014 and January 2016. Specimens from nose, throat, groin skin, and urine were sent for
bacteriologic culture and sensitivity test. Analysis cost-effectiveness was then performed for decolonization programme.
Results: Patients had positive cultures from nose (15.9%), throat (4.4%), groin skin (3.1%), and urine (0.9%). In
general, 20.8% of the patients had positive cultures for staphylococcus aureus, among whom, 1.8% were methicillin
resistant. Based on cost-effectiveness analysis, decolonization program leads to 80% reduction in costs.
Conclusion: According to our results, although colonization with methicillin sensitive staphylococcus aureus in patients
undergoing hip or knee arthroplasty is lower than other studies but colonization with methicillin resistant staphylococcus
aureus is similar to others. Also, decolonization programme in these patients was found to be very cost-effective.
Level of evidence: II


Main Subjects