“If it’s good enough for me…”


I do a fair bit of running, and I often think about what condition my joints will be in thirty years down the line.

Because I am a microbiologist I see first hand the devastation that can be caused by an early prosthetic joint infection (PJI) with Staphylococcus aureus.

It actually doesn’t matter whether it’s MSSA or MRSA. Either way, it’s not pretty…

For this reason, and in the knowledge that most Staphylococcus aureus PJIs are usually caused by the patient’s own colonising flora, I would be very keen to ensure that my nasal area is completely clear of Staphylococcus aureus before going under the knife.

And if it’s good enough for me, then I should definitely be considering it for my patients, and I am. The evidence is building, slowly but surely, that this is a very reasonable thing to do.

See here and here for a couple of sample papers.

There are essentially two ways to approach this:

  • Screen all patients pre-operatively for Staphyococus aureus and then give mupirocin (or another antibiotic) to those that are culture positive on screening culture.
  • Give all patients intra-nasal mupirocin prior to hip and knee joint arthroplasty surgery.

And often chlorhexidine body washes are thrown in as well to form a “bundle”.

I know there may be some institutions which are already performing Staphylococcus aureus decolonisation prior to joint replacement, but in my experience it certainly is not common practice (yet) in New Zealand. However that does not mean it is not the correct thing to do…

Obviously one would need to monitor mupirocin resistance rates, but on a population scale, giving mupirocin to a few hundred patients in a focused fashion like this does not actually represent a lot of selection pressure.

There are certainly plenty of my peers who would do exactly the same as I would when my joints wear out, even if it wasn’t “standard practice”. This is telling me something, and I hate to see “us and them” medicine practiced.

If it’s good enough for me…


2 thoughts on ““If it’s good enough for me…”

  1. Hi Micheal,

    I would certainly do the same. Have you or your New Zealand colleagues considered decolonisation with a non-cytotoxic topical antiseptic, rather than a topical antibiotic?


    1. Hi Scott

      Are you thinking of something like povidone-iodine, which there is now a fair bit of evidence for. Absolutely, this very question is being discussed nationally in New Zealand as part of a national roll-out of a “Staphylococcal bundle” prior to joint replacement. Good point.
      Thanks for your comment.

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