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her patients have S. aureus and 1 to 5% test positive for MRSA.
S. aureus accounts for the majority of SSIs in orthopedic patients, says Dr.
Chen, who notes that SSIs associated with S. aureus following joint replace-
ment procedures are difficult to treat, because the bacteria forms a biofilm on
implants that's often resistant to antibiotic treatment.
The cost of screening is facility-dependent, but a nasal swab and culture test
typically runs about $20 and intranasal mupirocin is about $90. "We're not talk-
ing about thousands of dollars," says Dr. Chen. "But you also have to consider
the indirect staffing costs associated with swabbing patients, following up on
lab results and calling in antibiotic prescriptions to treat patients who test posi-
tive."
Dr. Chen cites research that says a 35% reduction in the revision rate for total
hip and knee replacements and a 10% reduction in the revision rate for spine
surgery are needed to make screening and decolonization cost-effective. But in
her mind, the cost of preventing just one surgical site infection is worth the
screening and treatment process.
Some experts advocate for treating all patients as if they have S. aureus,
even if they screen negative, says Dr. Chen. However, she doesn't recommend
treating every patient with mupirocin for a possible infection, because it could
points out, that reduction would prevent 5 infections for every 1,000 patients
treated.
At NYU Langone, the approximate per-patient charge for nasal screening and
prophylaxis with mupirocin is $105 — a relatively low figure, especially when
you consider the high cost of treating just one surgical site infection, says Dr.
Slover. He says any significant reduction in infection rates will be highly cost-
effective. "If we can establish that," says Dr. Slover, "then screening and decol-
onization is likely to become a widely used pre-operative infection control
intervention."
— Daniel Cook
