Volume 8, Issue 3, June 2020, Page: 81-85
The Efficacy of an Octenidine Decolonisation Protocol in Reducing Staphylococcus Aureus Carriage in Patients Undergoing Total Joint Arthroplasty
Tristan Symonds, Orthopaedic Research Institute of Queensland, Townsville, Queensland
Hannah Brien, Cairns Private Hospital, Cairns, Queensland
Benjamin Parkinson, Orthopaedic Research Institute of Queensland, Townsville, Queensland; Cairns Private Hospital, Cairns, Queensland
Andrea Grant, Orthopaedic Research Institute of Queensland, Townsville, Queensland
Kenji Doma, Orthopaedic Research Institute of Queensland, Townsville, Queensland
Received: Apr. 7, 2020;       Accepted: Apr. 26, 2020;       Published: May 19, 2020
DOI: 10.11648/j.js.20200803.11      View  28      Downloads  29
Prosthetic joint infections are responsible for a high morbidity and economic cost in patients undergoing total joint arthroplasty. Staphylococcus aureus (S Aureus) is a key modifiable risk factor in the reduction of surgical site infections (SSI). Evidence suggests that decolonization of S aureus carriers reduces the risk of SSI. Octenidine is an antiseptic active against gram-positive and gram-negative bacteria. The aim of this study is to establish the eradication rate of S aureus in patients undergoing total joint arthroplasty using an Octenidine decolonisation protocol prior to surgery. This was a prospective case series performed at the Cairns Private Hospital during a five month trial period of using Octenidine wash and nasal gel in patients undergoing elective TJA. Patients undergoing total joint arthroplasty during a five-month trial period had pre-operative nasal swabs to screen for S aureus pre and post Octenidine treatment. All patients underwent a body wash and nasal gel protocol for five days using Octenidine. The primary outcome was to determine decolonisation rates in patients following the protocol. A total of 183 patients met inclusion criteria into this study. At the first swab 151 (82.5%) patients had normal regional flora and 32 (17.5%) were positive for S aureus. Of these 32 patients 30 (93.75%) were negative for MRSA and 2 (6.25%) had non-multiresistant MRSA. The decolonization rate for patients with S aureus was 76.6%. It was unsuccessful in clearing the two patients with nmMRSA. Octenidine is effective in reducing S aureus colonisation in patients undergoing total joint arthroplasty. Further studies are required to compare this agent to traditional mupirocin based protocols to determine its efficacy as an alternative for use in pre-operative staphylococcal decolonisation.
Total Joint Arthroplasty, Decolonization, Octenidine, Staphylococcus Aureus, Prosthetic Joint Infections
To cite this article
Tristan Symonds, Hannah Brien, Benjamin Parkinson, Andrea Grant, Kenji Doma, The Efficacy of an Octenidine Decolonisation Protocol in Reducing Staphylococcus Aureus Carriage in Patients Undergoing Total Joint Arthroplasty, Journal of Surgery. Vol. 8, No. 3, 2020, pp. 81-85. doi: 10.11648/j.js.20200803.11
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Chen AF, Wessel CB, Rao N. Staphylococcus aureus screening and decolonization in orthopaedic surgery and reduction of surgical site infections. Clinical orthopaedics and related research. 2013; 471 (7): 2383-99.
Wilcox MH, Hall J, Pike H, Templeton PA, Fawley WN, Parnell P, et al. Use of perioperative mupirocin to prevent methicillin-resistant Staphylococcus aureus (MRSA) orthopaedic surgical site infections. The Journal of hospital infection. 2003; 54 (3): 196-201.
Gernaat-van der Sluis AJ, Hoogenboom-Verdegaal AM, Edixhoven PJ, Spies-van Rooijen NH. Prophylactic mupirocin could reduce orthopedic wound infections. 1,044 patients treated with mupirocin compared with 1,260 historical controls. Acta orthopaedica Scandinavica. 1998; 69 (4): 412-4.
Rao N, Cannella B, Crossett LS, Yates AJ, Jr., McGough R, 3rd. A preoperative decolonization protocol for staphylococcus aureus prevents orthopaedic infections. Clinical orthopaedics and related research. 2008; 466 (6): 1343-8.
Coates T, Bax R, Coates A. Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects. The Journal of antimicrobial chemotherapy. 2009; 64 (1): 9-15.
Tsang STJ, McHugh MP, Guerendiain D, Gwynne P, Boyd J, Laurenson IF, et al. Evaluation of Staphylococcus aureus eradication therapy in orthopaedic surgery. Journal of Medical Microbiology. 2018; 67 (6): 893-901.
Fujimura S, Watanabe A. Survey of high- and low-level mupirocin-resistant strains of methicillin-resistant Staphylococcus aureus in 15 Japanese hospitals. Chemotherapy. 2003; 49 (1-2): 36-8.
Simor AE, Stuart TL, Louie L, Watt C, Ofner-Agostini M, Gravel D, et al. Mupirocin-resistant, methicillin-resistant Staphylococcus aureus strains in Canadian hospitals. Antimicrobial agents and chemotherapy. 2007; 51 (11): 3880-6.
Stambough JB, Nam D, Warren DK, Keeney JA, Clohisy JC, Barrack RL, et al. Decreased Hospital Costs and Surgical Site Infection Incidence With a Universal Decolonization Protocol in Primary Total Joint Arthroplasty. The Journal of arthroplasty. 2017; 32 (3): 728-34. e1.
Axel Kramer OA. Octenidine, Chlorhexidine, Iodine and Iodophores. Preprint from Wallhäußers Praxis der Sterilisation, Antiseptik und Konservierung: Thieme Georg Verlag; 2008.
Assadian O. Octenidine dihydrochloride: chemical characteristics and antimicrobial properties. Journal of wound care. 2016; 25 (3 Suppl): S3-6.
Al-Doori Z, Goroncy-Bermes P, Gemmell CG, Morrison D. Low-level exposure of MRSA to octenidine dihydrochloride does not select for resistance. The Journal of antimicrobial chemotherapy. 2007; 59 (6): 1280-1.
Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. The New England journal of medicine. 2002; 346 (24): 1871-7.
Doebbeling BN, Breneman DL, Neu HC, Aly R, Yangco BG, Holley HP, Jr., et al. Elimination of Staphylococcus aureus nasal carriage in health care workers: analysis of six clinical trials with calcium mupirocin ointment. The Mupirocin Collaborative Study Group. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 1993; 17 (3): 466-74.
Konvalinka A, Errett L, Fong IW. Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery. The Journal of hospital infection. 2006; 64 (2): 162-8.
Krishna BV, Gibb AP. Use of octenidine dihydrochloride in meticillin-resistant Staphylococcus aureus decolonisation regimens: a literature review. The Journal of hospital infection. 2010; 74 (3): 199-203.
Rohr U, Mueller C, Wilhelm M, Muhr G, Gatermann S. Methicillin-resistant Staphylococcus aureus whole-body decolonization among hospitalized patients with variable site colonization by using mupirocin in combination with octenidine dihydrochloride. The Journal of hospital infection. 2003; 54 (4): 305-9.
Sloot N, Siebert J, Hoffler U. Eradication of MRSA from carriers by means of whole-body washing with an antiseptic in combination with mupirocin nasal ointment. Zentralblatt fur Hygiene und Umweltmedizin=International journal of hygiene and environmental medicine. 1999; 202 (6): 513-23.
Rengelshausen J, Nürnberger J, Philipp T, Kribben A. Decolonization of methicillin-resistant Staphylococcus aureus by disinfection of the skin. The American Journal of Medicine. 2000; 108 (8): 685-6.
Hansen D, Patzke PI, Werfel U, Benner D, Brauksiepe A, Popp W. Success of MRSA eradication in hospital routine: depends on compliance. Infection. 2007; 35 (4): 260-4.
Pichler G PC, Babeluk R, et al. MRSA prevalence rates detected in a tertiary care hospital in Austria and successful treatment of MRSA positive patients applying a decontamination regime with octenidine. Eur J Clin Microbiol Infect Dis. 2017; 37 (21).
Fritz SA, Camins BC, Eisenstein KA, Fritz JM, Epplin EK, Burnham CA, et al. Effectiveness of measures to eradicate Staphylococcus aureus carriage in patients with community-associated skin and soft-tissue infections: a randomized trial. Infection control and hospital epidemiology. 2011; 32 (9): 872-80.
Caffrey AR, Woodmansee SB, Crandall N, Tibert C, Fielding C, Mikolich DJ, et al. Low adherence to outpatient preoperative methicillin-resistant Staphylococcus aureus decolonization therapy. Infection control and hospital epidemiology. 2011; 32 (9): 930-2.
Hetem DJ, Bonten MJ. Clinical relevance of mupirocin resistance in Staphylococcus aureus. The Journal of hospital infection. 2013; 85 (4): 249-56.
Rajkumari N, Mathur P, Bhardwaj N, Gupta G, Dahiya R, Behera B, et al. Resistance pattern of mupirocin in methicillin-resistant Staphylococcus aureus in trauma patients and comparison between disc diffusion and E-test for better detection of resistance in low resource countries. J Lab Physicians. 2014; 6 (2): 91-5.
Browse journals by subject