Screening and decolonization of MRSA among joint arthroplasty patients: efficacy, cost-effectiveness and durability

To review the literature with the aim of answering the following three questions: 1) Is screening and decolonization effective in reducing the rate of infection after elective joint arthroplasty? 2) Is screening and decolonization cost-effective? 3) What is the durability of decolonization? The search engines were MedLine (PubMed), Google Scholar and the Cochrane Library. The keywords used were: preoperative MRSA screening. Seven thousand nine hundred and forty eight articles were found until 30 September 2014 (seven thousand eight hundred and fifty in Google Scholar, ninety-seven in MedLine and one in the Cochrane Library). Of those, only eighteen were selected and reviewed because they were strictly focused on the question of this article. The types of studies reported have a low level of evidence. Most of them are prospective case series, although some of them are systematic reviews of level III studies. There is a tendency toward fewer MRSA infections after elective joint arthroplasty. Decolonization has shown to be strongly cost-effective with 33% of postoperative arthroplasty patients tests positive for Staphylococcus aureus colonization at 3 to 30 months after surgery. There is a tendency toward fewer MRSA infections after total joint arthroplasty when screening and decolonization is used. Decolonization is strongly cost-effective procedure with 33% of patients tests positive for MRSA 3 to 30 months after surgery. Larger, randomized, controlled studies are needed to confirm the apparent efficacy of decolonization.