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J Arthroplasty. 2019 Jan 17. pii: S0883-5403(19)30052-X. doi: 10.1016/j.arth.2019.01.025. [Epub ahead of print]

Increased Staphylococcus aureus Nasal Carriage Rates in Rheumatoid Arthritis Patients on Biologic Therapy.

Author information

1
Department of Medicine, Hospital for Special Surgery, Weill-Cornell Medical School, New York, NY.
2
Division of Infectious Diseases, Department of Medicine, NYU School of Medicine, New York, NY.

Abstract

BACKGROUND:

Rheumatoid arthritis patients are at increased risk for periprosthetic joint infection after arthroplasty. The reason is multifactorial. Nasal colonization with Staphylococcus aureus is a modifiable risk factor; carriage rates in RA patients are unknown. The goal of this study is to determine the S aureus nasal carriage rates of RA patients on biologics, RA patients on traditional disease-modifying anti-rheumatic drugs (DMARDs), and osteoarthritis.

METHODS:

Consecutive patients with RA on biologics (±DMARDs), RA on non-biologic DMARDs, or OA were prospectively enrolled from April 2017 to May 2018. One hundred twenty-three patients were determined necessary per group to show a difference in carriage rates. Patients underwent a nasal swab and answered questions to identify additional risk factors. S aureus positive swabs were further categorized using spa typing. Logistic regression evaluated the association with S aureus colonization between the groups after controlling for known risk factors.

RESULTS:

RA patients on biologics, 70% of whom were on DMARDs, had statistically significant increase in S aureus colonization (37%) compared to RA on DMARDs alone (24%), or OA (20%) (P = .01 overall). After controlling for glucocorticoids, antibiotic use, recent hospitalization, and diabetes, RA on biologics had a significant increased risk of S aureus nasal colonization (Odds ratio 1.80, 95% confidence interval 1.00-3.22, P = .047).

CONCLUSION:

S aureus colonization risk was increased for RA on biologics compared to RA not on biologics and OA. Nasal S aureus carriage increases the risk of surgical site infection; this modifiable risk factor should be addressed prior to total joint arthroplasty for this higher risk patient group.

KEYWORDS:

Staphylococcus aureus colonization; biologics; osteoarthritis; periprosthetic joint infection; rheumatoid arthritis; tumor necrosis factor inhibitors

PMID:
30733073
DOI:
10.1016/j.arth.2019.01.025

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