Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed

S. T.J. Tsang; M. P. McHugh; D. Guerendiain; P. J. Gwynne; J. Boyd; A. H. R. W. Simpson; T. S. Walsh; I. F. Laurenson; K. E. Templeton

doi:10.1302/2046-3758.71.BJR-2017-0175.R1

Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed

S. T.J. Tsang^*, M. P. McHugh, D. Guerendiain, P. J. Gwynne, J. Boyd, A. H. R. W. Simpson, T. S. Walsh, I. F. Laurenson, K. E. Templeton

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives

Nasal carriers of Staphylococcus (S.) aureus (MRSA and MSSA) have an increased risk for healthcare-associated infections. There are currently limited national screening policies for the detection of S. aureus despite the World Health Organization’s recommendations. This study aimed to evaluate the diagnostic performance of molecular and culture techniques in S. aureus screening, determine the cause of any discrepancy between the diagnostic techniques, and model the potential effect of different diagnostic techniques on S. aureus detection in orthopaedic patients.

Methods

Paired nasal swabs for polymerase chain reaction (PCR) assay and culture of S. aureus were collected from a study population of 273 orthopaedic outpatients due to undergo joint arthroplasty surgery.

Results

The prevalence of MSSA nasal colonization was found to be between 22.4% to 35.6%. The current standard direct culturing methods for detecting S. aureus significantly underestimated the prevalence (p = 0.005), failing to identify its presence in approximately one-third of patients undergoing joint arthroplasty surgery.

Conclusion

Modelling these results to national surveillance data, it was estimated that approximately 5000 to 8000 S. aureus surgical site infections could be prevented, and approximately $140 million to $950 million (approximately £110 million to £760 million) saved in treatment costs annually in the United States and United Kingdom combined, by using alternative diagnostic methods to direct culture in preoperative S. aureus screening and eradication programmes.

Original language	English
Pages (from-to)	79-84
Number of pages	6
Journal	Bone & Joint Research
Volume	7
Issue number	1
DOIs	https://doi.org/10.1302/2046-3758.71.BJR-2017-0175.R1
Publication status	Published - 12 Jan 2018

Keywords

Periprosthetic joint infection
Staphylococcus aureus
Surgical site infection

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Tsang_2018_BJR_Standardculturing_CC
Copyright © 2018 Tsang et al. This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.
Final published version, 524 KBLicence: CC BY-NC

Cite this

Tsang, S. T. J., McHugh, M. P., Guerendiain, D., Gwynne, P. J., Boyd, J., Simpson, A. H. R. W., Walsh, T. S., Laurenson, I. F., & Templeton, K. E. (2018). Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed. Bone & Joint Research, 7(1), 79-84. https://doi.org/10.1302/2046-3758.71.BJR-2017-0175.R1

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title = "Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed",

abstract = "ObjectivesNasal carriers of Staphylococcus (S.) aureus (MRSA and MSSA) have an increased risk for healthcare-associated infections. There are currently limited national screening policies for the detection of S. aureus despite the World Health Organization{\textquoteright}s recommendations. This study aimed to evaluate the diagnostic performance of molecular and culture techniques in S. aureus screening, determine the cause of any discrepancy between the diagnostic techniques, and model the potential effect of different diagnostic techniques on S. aureus detection in orthopaedic patients.MethodsPaired nasal swabs for polymerase chain reaction (PCR) assay and culture of S. aureus were collected from a study population of 273 orthopaedic outpatients due to undergo joint arthroplasty surgery.ResultsThe prevalence of MSSA nasal colonization was found to be between 22.4% to 35.6%. The current standard direct culturing methods for detecting S. aureus significantly underestimated the prevalence (p = 0.005), failing to identify its presence in approximately one-third of patients undergoing joint arthroplasty surgery.ConclusionModelling these results to national surveillance data, it was estimated that approximately 5000 to 8000 S. aureus surgical site infections could be prevented, and approximately $140 million to $950 million (approximately £110 million to £760 million) saved in treatment costs annually in the United States and United Kingdom combined, by using alternative diagnostic methods to direct culture in preoperative S. aureus screening and eradication programmes.",

keywords = "Periprosthetic joint infection, Staphylococcus aureus, Surgical site infection",

author = "Tsang, {S. T.J.} and McHugh, {M. P.} and D. Guerendiain and Gwynne, {P. J.} and J. Boyd and Simpson, {A. H. R. W.} and Walsh, {T. S.} and Laurenson, {I. F.} and Templeton, {K. E.}",

note = "This research was supported by the Royal College of Surgeons Edinburgh (Joint RC SEd/Cutner Research fellowship awarded to S. T. J. Tsang), Leonardo (Selex Medical) (Research grant awarded to T. S. Walsh), and Arthritis Research UK (Research grant awarded to A. H. R. W. Simpson).",

year = "2018",

month = jan,

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doi = "10.1302/2046-3758.71.BJR-2017-0175.R1",

language = "English",

volume = "7",

pages = "79--84",

journal = "Bone & Joint Research",

issn = "2046-3758",

publisher = "The British Editorial Society of Bone & Joint Surgery",

number = "1",

}

Tsang, STJ, McHugh, MP, Guerendiain, D, Gwynne, PJ, Boyd, J, Simpson, AHRW, Walsh, TS, Laurenson, IF & Templeton, KE 2018, 'Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed', Bone & Joint Research, vol. 7, no. 1, pp. 79-84. https://doi.org/10.1302/2046-3758.71.BJR-2017-0175.R1

TY - JOUR

T1 - Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques

T2 - One third of carriers missed

AU - Tsang, S. T.J.

AU - McHugh, M. P.

AU - Guerendiain, D.

AU - Gwynne, P. J.

AU - Boyd, J.

AU - Simpson, A. H. R. W.

AU - Walsh, T. S.

AU - Laurenson, I. F.

AU - Templeton, K. E.

N1 - This research was supported by the Royal College of Surgeons Edinburgh (Joint RC SEd/Cutner Research fellowship awarded to S. T. J. Tsang), Leonardo (Selex Medical) (Research grant awarded to T. S. Walsh), and Arthritis Research UK (Research grant awarded to A. H. R. W. Simpson).

PY - 2018/1/12

Y1 - 2018/1/12

N2 - ObjectivesNasal carriers of Staphylococcus (S.) aureus (MRSA and MSSA) have an increased risk for healthcare-associated infections. There are currently limited national screening policies for the detection of S. aureus despite the World Health Organization’s recommendations. This study aimed to evaluate the diagnostic performance of molecular and culture techniques in S. aureus screening, determine the cause of any discrepancy between the diagnostic techniques, and model the potential effect of different diagnostic techniques on S. aureus detection in orthopaedic patients.MethodsPaired nasal swabs for polymerase chain reaction (PCR) assay and culture of S. aureus were collected from a study population of 273 orthopaedic outpatients due to undergo joint arthroplasty surgery.ResultsThe prevalence of MSSA nasal colonization was found to be between 22.4% to 35.6%. The current standard direct culturing methods for detecting S. aureus significantly underestimated the prevalence (p = 0.005), failing to identify its presence in approximately one-third of patients undergoing joint arthroplasty surgery.ConclusionModelling these results to national surveillance data, it was estimated that approximately 5000 to 8000 S. aureus surgical site infections could be prevented, and approximately $140 million to $950 million (approximately £110 million to £760 million) saved in treatment costs annually in the United States and United Kingdom combined, by using alternative diagnostic methods to direct culture in preoperative S. aureus screening and eradication programmes.

AB - ObjectivesNasal carriers of Staphylococcus (S.) aureus (MRSA and MSSA) have an increased risk for healthcare-associated infections. There are currently limited national screening policies for the detection of S. aureus despite the World Health Organization’s recommendations. This study aimed to evaluate the diagnostic performance of molecular and culture techniques in S. aureus screening, determine the cause of any discrepancy between the diagnostic techniques, and model the potential effect of different diagnostic techniques on S. aureus detection in orthopaedic patients.MethodsPaired nasal swabs for polymerase chain reaction (PCR) assay and culture of S. aureus were collected from a study population of 273 orthopaedic outpatients due to undergo joint arthroplasty surgery.ResultsThe prevalence of MSSA nasal colonization was found to be between 22.4% to 35.6%. The current standard direct culturing methods for detecting S. aureus significantly underestimated the prevalence (p = 0.005), failing to identify its presence in approximately one-third of patients undergoing joint arthroplasty surgery.ConclusionModelling these results to national surveillance data, it was estimated that approximately 5000 to 8000 S. aureus surgical site infections could be prevented, and approximately $140 million to $950 million (approximately £110 million to £760 million) saved in treatment costs annually in the United States and United Kingdom combined, by using alternative diagnostic methods to direct culture in preoperative S. aureus screening and eradication programmes.

KW - Periprosthetic joint infection

KW - Staphylococcus aureus

KW - Surgical site infection

U2 - 10.1302/2046-3758.71.BJR-2017-0175.R1

DO - 10.1302/2046-3758.71.BJR-2017-0175.R1

M3 - Article

AN - SCOPUS:85040583903

SN - 2046-3758

VL - 7

SP - 79

EP - 84

JO - Bone & Joint Research

JF - Bone & Joint Research

IS - 1

ER -

Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed

Abstract

Keywords

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