Effectiveness of preoperative decolonization with nasal povidone iodine in Chinese patients undergoing elective orthopedic surgery: a prospective cross-sectional study

Staphylococcus aureus colonization in the nares of patients undergoing elective orthopedic surgery increases the potential risk of surgical site infections. Methicillin-resistant S. aureus (MRSA) has gained recognition as a pathogen that is no longer only just a hospital-acquired pathogen. Patients positive for MRSA are associated with higher rates of morbidity and mortality following infection. MRSA is commonly found in the nares, and methicillin-sensitive S. aureus (MSSA) is even more prevalent. Recently, studies have determined that screening for this pathogen prior to surgery and diminishing staphylococcal infections at the surgical site will dramatically reduce surgical site infections. A nasal mupirocin treatment is shown to significantly reduce the colonization of the pathogen. However, this treatment is expensive and is currently not available in China. Thus, in this study, we first sought to determine the prevalence of MSSA/MSRA in patients undergoing elective orthopedic surgery in northern China, and then, we treated the positive patients with a nasal povidone-iodine swab. Here, we demonstrate a successful reduction in the colonization of S. aureus. We propose that this treatment could serve as a cost-effective means of eradicating this pathogen in patients undergoing elective orthopedic surgery, which might reduce the rate of surgical site infections.接受择期骨科手术患者的鼻腔定植金黄色葡萄球菌（Staphylococcus aureus），会提升手术部位感染的潜在风险。耐甲氧西林金黄色葡萄球菌（MRSA）现已被证实不再仅为医院获得性病原体，MRSA检测阳性患者在感染后并发症发生率与死亡率均显著升高。MRSA常定植于鼻腔，而甲氧西林敏感金黄色葡萄球菌（MSSA）的定植率更为普遍。近期已有研究证实，术前对该病原体进行筛查，并减少手术部位的葡萄球菌感染，可显著降低手术部位感染的发生率。鼻腔莫匹罗星治疗方案已被证实可显著降低该病原体的定植水平，但该治疗方案成本高昂，且目前国内尚无此类药物。因此，本研究首先旨在明确中国北方地区择期骨科手术患者中MSSA与MRSA的定植率，随后对检测结果为阳性的患者采用鼻腔聚维酮碘拭子治疗方案。本研究证实，该方案可成功降低金黄色葡萄球菌的定植率。我们认为，该治疗方案可作为一种经济有效的手段，在择期骨科手术患者中根除该病原体，从而有望降低手术部位感染的发生率。