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Preoperative Screening and Eradication of Infection

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The Infected Total Knee Arthroplasty

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Abstract

The screening for and treatment of asymptomatic bacterial colonization of the skin, mucus membranes and urinary tract are established orthopaedic practice. Eradication of methicillin-resistant Staphylococcus aureus (MRSA) from the nose and perineum prior to arthroplasty is common in the healthcare systems of most developed countries, and there is a substantial base of good-quality evidence to support this practice. Extending screening and eradication to encompass methicillin-sensitive staphylococcal strains (which cause PJI more commonly than MRSA) has been proposed, and studies exist which demonstrate significant reductions in PJI when sensitive strains are screened for. By contrast, the routine screening for and eradication of asymptomatic bacteriuria appear not to be effective on the basis of the current evidence, and there is increasing expert opinion against continued screening. Rationalization and standardization of preoperative screening policies have the potential to improve outcomes by reducing the incidence of PJI whilst minimizing the complications of the unnecessary use of antibiotics.

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Authors and Affiliations

  1. University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Alexander D. Liddle

  2. Department of Orthopaedic Surgery, “La Paz” University Hospital-IdiPaz, Paseo de la Castellana 261, 28046, Madrid, Spain

    E. Carlos Rodríguez-Merchán

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  1. Alexander D. Liddle
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Correspondence to Alexander D. Liddle .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. University College London Hospitals , London, United Kingdom

    Sam Oussedik

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Liddle, A.D., Rodríguez-Merchán, E.C. (2018). Preoperative Screening and Eradication of Infection. In: Rodríguez-Merchán, E., Oussedik, S. (eds) The Infected Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-66730-0_6

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  • DOI: https://doi.org/10.1007/978-3-319-66730-0_6

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