From the Guidelines
For MSSA decolonization prior to joint replacement, a recommended regimen includes intranasal mupirocin (Bactroban) 2% ointment applied to both nostrils twice daily for 5 days before surgery, combined with chlorhexidine gluconate 4% body wash daily for the same period, as supported by recent studies such as Sporer et al. [@15@] and Schweizer et al. [@34@]. This combination helps reduce Staphylococcus aureus colonization, particularly in the nares where MSSA commonly resides. The mupirocin works by inhibiting bacterial protein synthesis, while chlorhexidine disrupts bacterial cell membranes.
Key Considerations
- The decolonization protocol should be started approximately 5 days before the scheduled surgery date.
- For patients with documented MSSA infections rather than just colonization, appropriate systemic antibiotics like cefazolin should be administered as surgical prophylaxis.
- This regimen significantly reduces the risk of surgical site infections in joint replacement procedures, as MSSA remains a common pathogen in prosthetic joint infections, as seen in studies like Sun et al. [@77@] and Walsh et al. [@16@].
Patient Instructions
- Patients should be instructed to complete the full course even if they feel the application is unnecessary, as incomplete decolonization may reduce effectiveness.
- It is crucial to follow the prescribed regimen to minimize the risk of surgical site infections and ensure the best possible outcomes for joint replacement surgery, with evidence from Mallet et al. [@75@] and Saraswat et al. [@76@] supporting the importance of adherence to decolonization protocols.
From the Research
Bactriban Regimen for MSSA Prior to Joint Replacement
- There is no direct evidence regarding the use of Bactriban (a topical antibiotic ointment) as a regimen for MSSA prior to joint replacement in the provided studies.
- However, the studies do discuss the effectiveness of various antibiotics, including cefazolin, in preventing surgical site infections (SSI) and treating MSSA infections 1, 2, 3, 4, 5.
- Cefazolin is shown to be effective against MSSA, with a study finding that it has excellent coverage against MSSA 2.
- Another study found that cefazolin had a lower rate of SSI compared to prolonged post-surgical prophylaxis 1.
- The use of vancomycin, another antibiotic, is also discussed in the studies, with some finding that it is inferior to beta-lactams, such as cefazolin, for treatment of MSSA bloodstream infections 3, 4.
- A study comparing ceftriaxone and cefazolin for the treatment of MSSA bacteraemia found no difference in clinical cure rates between the two antibiotics 5.
- Overall, while there is no direct evidence on the use of Bactriban for MSSA prior to joint replacement, the studies suggest that cefazolin is an effective antibiotic against MSSA and may be a suitable choice for preventing SSI in joint replacement surgery.