metricas
covid
Buscar en
Revista Española de Cirugía Ortopédica y Traumatología
Toda la web
Inicio Revista Española de Cirugía Ortopédica y Traumatología Results of a preoperative screening and decolonization programme for Staphyloco...
Journal Information

Statistics

Follow this link to access the full text of the article

Original Paper
Results of a preoperative screening and decolonization programme for Staphylococcus aureus in primary hip and knee arthroplasty
Resultados de un programa de descolonización de Staphylococcus aureus en cirugía protésica primaria de cadera y rodilla
E. Yuste Berenguera,
Corresponding author
eybarnau@gmail.com

Corresponding author.
, J. Colomina Moralesb, P. Señor Revueltoa, R. Drudis Morellc, M. Torra Rierac, E.P. Pilares Ortegab, J. Trujillano Cabellod
a Servicio de COT, Hospital Universitari Arnau de Vilanova, Lleida, Spain
b Servicio de COT, Hospital Universitari de Santa Maria, Lleida, Spain
c Servicio de Anestesiología y Reanimación, Hospital Universitari de Santa María, Lleida, Spain
d Servicio de Cuidados Intensivos, Hospital Universitari Arnau de Vialnova, Lleida, Spain
Read
806
Times
was read the article
147
Total PDF
659
Total HTML
Share statistics
 array:24 [
  "pii" => "S1888441523000838"
  "issn" => "18884415"
  "doi" => "10.1016/j.recot.2023.02.017"
  "estado" => "S300"
  "fechaPublicacion" => "2023-07-01"
  "aid" => "1201"
  "copyright" => "SECOT"
  "copyrightAnyo" => "2022"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Esp Cir Ortop Traumatol. 2023;67:T309-T316"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1888441522003666"
    "issn" => "18884415"
    "doi" => "10.1016/j.recot.2022.12.016"
    "estado" => "S300"
    "fechaPublicacion" => "2023-07-01"
    "aid" => "1177"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2023;67:317-23"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Paper</span>"
      "titulo" => "Midterm outcomes of patellofemoral arthroplasty"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "317"
          "paginaFinal" => "323"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Resultados a medio plazo de la artroplastia femoropatelar"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2875
              "Ancho" => 1321
              "Tamanyo" => 171213
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">FAVA femoral anteversion angle &#40;a&#41;&#44; patella tilt &#40;b&#41;&#44; and tibial tuberosity&#8211;trochlear groove distance &#40;TTTG&#41; angle &#40;c&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "B&#46; Mart&#237;nez-Sa&#241;udo, S&#46; Fornell, M&#46; Vallejo, G&#46; Domecq"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Mart&#237;nez-Sa&#241;udo"
            ]
            1 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Fornell"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Vallejo"
            ]
            3 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Domecq"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441522003666?idApp=UINPBA00004N"
    "url" => "/18884415/0000006700000004/v3_202404150749/S1888441522003666/v3_202404150749/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1888441522003083"
    "issn" => "18884415"
    "doi" => "10.1016/j.recot.2022.11.002"
    "estado" => "S300"
    "fechaPublicacion" => "2023-07-01"
    "aid" => "1154"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2023;67:309-16"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Resultados de un programa de descolonizaci&#243;n de <span class="elsevierStyleItalic">Staphylococcus aureus</span> en cirug&#237;a prot&#233;sica primaria de cadera y rodilla"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "309"
          "paginaFinal" => "316"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Results of a preoperative screening and decolonization program for <span class="elsevierStyleItalic">Staphylococcus aureus</span> in primary hip and knee arthroplasty"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1824
              "Ancho" => 2508
              "Tamanyo" => 261474
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Resultados en cohorte hist&#243;rica y grupo de intervenci&#243;n&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Yuste Berenguer, J&#46; Colomina Morales, P&#46; Se&#241;or Revuelto, R&#46; Drudis Morell, M&#46; Torra Riera, E&#46;P&#46; Pilares Ortega, J&#46; Trujillano Cabello"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Yuste Berenguer"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Colomina Morales"
            ]
            2 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Se&#241;or Revuelto"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Drudis Morell"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Torra Riera"
            ]
            5 => array:2 [
              "nombre" => "E&#46;P&#46;"
              "apellidos" => "Pilares Ortega"
            ]
            6 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Trujillano Cabello"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441522003083?idApp=UINPBA00004N"
    "url" => "/18884415/0000006700000004/v3_202404150749/S1888441522003083/v3_202404150749/es/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:18 [
      "pii" => "S1888441522003083"
      "issn" => "18884415"
      "doi" => "10.1016/j.recot.2022.11.002"
      "estado" => "S300"
      "fechaPublicacion" => "2023-07-01"
      "aid" => "1154"
      "copyright" => "SECOT"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Esp Cir Ortop Traumatol. 2023;67:309-16"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Resultados de un programa de descolonizaci&#243;n de <span class="elsevierStyleItalic">Staphylococcus aureus</span> en cirug&#237;a prot&#233;sica primaria de cadera y rodilla"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "309"
            "paginaFinal" => "316"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Results of a preoperative screening and decolonization program for <span class="elsevierStyleItalic">Staphylococcus aureus</span> in primary hip and knee arthroplasty"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1824
                "Ancho" => 2508
                "Tamanyo" => 261474
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Resultados en cohorte hist&#243;rica y grupo de intervenci&#243;n&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "E&#46; Yuste Berenguer, J&#46; Colomina Morales, P&#46; Se&#241;or Revuelto, R&#46; Drudis Morell, M&#46; Torra Riera, E&#46;P&#46; Pilares Ortega, J&#46; Trujillano Cabello"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Yuste Berenguer"
              ]
              1 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Colomina Morales"
              ]
              2 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Se&#241;or Revuelto"
              ]
              3 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Drudis Morell"
              ]
              4 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Torra Riera"
              ]
              5 => array:2 [
                "nombre" => "E&#46;P&#46;"
                "apellidos" => "Pilares Ortega"
              ]
              6 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Trujillano Cabello"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441522003083?idApp=UINPBA00004N"
      "url" => "/18884415/0000006700000004/v3_202404150749/S1888441522003083/v3_202404150749/es/main.assets"
    ]
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Paper</span>"
    "titulo" => " Results of a preoperative screening and decolonization programme for <span class="elsevierStyleItalic">Staphylococcus aureus</span> in primary hip and knee arthroplasty"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "T309"
        "paginaFinal" => "T316"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "E&#46; Yuste Berenguer, J&#46; Colomina Morales, P&#46; Se&#241;or Revuelto, R&#46; Drudis Morell, M&#46; Torra Riera, E&#46;P&#46; Pilares Ortega, J&#46; Trujillano Cabello"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "E&#46;"
            "apellidos" => "Yuste Berenguer"
            "email" => array:1 [
              0 => "eybarnau@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Colomina Morales"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Se&#241;or Revuelto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Drudis Morell"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Torra Riera"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "E&#46;P&#46;"
            "apellidos" => "Pilares Ortega"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Trujillano Cabello"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de COT&#44; Hospital Universitari Arnau de Vilanova&#44; Lleida&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de COT&#44; Hospital Universitari de Santa Maria&#44; Lleida&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Anestesiolog&#237;a y Reanimaci&#243;n&#44; Hospital Universitari de Santa Mar&#237;a&#44; Lleida&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Cuidados Intensivos&#44; Hospital Universitari Arnau de Vialnova&#44; Lleida&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Resultados de un programa de descolonizaci&#243;n de <span class="elsevierStyleItalic">Staphylococcus aureus</span> en cirug&#237;a prot&#233;sica primaria de cadera y rodilla"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1824
            "Ancho" => 2508
            "Tamanyo" => 290362
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Results in a historical cohort and an intervention group&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Infection of the prosthesis is one of the most feared complications in total arthroplasties of the hip &#40;THA&#41; and knee &#40;TKA&#41;&#46; It has a prevalence of from 1&#37; to 3&#37; in total knee arthroplasty and from 0&#46;7&#37; to 2&#46;5&#37; in hip arthroplasty&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Infection of the prosthesis increases the duration of hospitalization&#44; leads to multiple interventions&#44; delays recovery and increases the risk of mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Furthermore&#44; direct medical costs after revision surgery of THA or TKA increase greatly&#44; above all in cases of surgery in 2 acts&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several risk factors are associated with infection of the prosthesis<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a>&#59; colonization by nasal<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> or cutaneous<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7</span></a><span class="elsevierStyleItalic">Staphylococcus aureus</span> is one such factor&#44; although it is not clear whether it is solely due to the colonization&#44; or to a combination of this with other factors&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;8</span></a> given that infections by the said micro-organism may also arise in patients who are not carriers&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Staphylococcus</span> species is the main causal agent of infection of the surgical site and prosthesis&#44; in more than 60&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> Of these&#44; in some series coagulase negative staphylococcus &#40;CNS&#41; such as <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> and <span class="elsevierStyleItalic">Staphylococcus haemolyticus</span> predominate&#44; while in other series&#44; such as the one by Sousa et al&#46;&#44; the predominant agent is <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; in 41&#46;2&#37; of cases&#59; the remaining 17&#46;6&#37; are methicillin-resistant strains &#40;MRSA&#41; and 23&#46;5&#37; are sensitive &#40;MSSA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> MRSA strains are more virulent&#44; and treating them is more complex&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S&#46; aureus</span> is a commensal micro-organism which is found in the skin and mucus membranes of 30&#37; of the patients who are subjected to a total arthroplasty&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#8211;8</span></a> and in 1&#37; of these cases it is MRSA&#46; Some longitudinal studies show that up to 20&#37; of the population are permanent carriers of <span class="elsevierStyleItalic">S&#46; aureus</span> and that 30&#37; are intermittent carriers&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Some protocols&#44; studies and institutions recommend the nasal decolonization of <span class="elsevierStyleItalic">S&#46; aureus</span> prior to surgery&#44; with the aim of reducing the risk of prosthesis infection&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Nevertheless&#44; there is no general consensus on this&#44; as logistical and economic implications have to be taken into consideration&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">With respect to the nasal decolonization protocol&#44; retrospective studies suggest that universal preoperative treatment with topical antiseptic and the examination&#44; detection and treatment of carriers may both be beneficial&#44; as they reduce infections of the surgical site in general&#46; This is also so specifically for <span class="elsevierStyleItalic">S&#46; aureus</span> and MRSA after orthopaedic surgery&#44; although there is no consensus as to which of the two methods is the most efficient and cost-effective&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> There are different alternative methods of screening&#58; on the one hand&#44; there is standard culture that may be exclusively nasal or taken from different areas of the body&#44; with variable sensitivity&#44; or detection techniques using molecular polymerase chain reason &#40;PCR&#41;&#46; Although the latter gives results more quickly&#44; it is more expensive and has not been shown to have any clear advantage&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Decolonization treatment consists of intranasal mupirocin which may or may not be combined with the topical chlorhexidine gluconate used in the shower&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Although detection and decolonization protocols have been shown to be highly successful&#44; some studies have demonstrated that colonization persists in up to 20&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;16&#8211;18</span></a> It is therefore important to confirm decolonization at least 3 weeks prior to surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The objectives of this study are to evaluate the efficacy of a <span class="elsevierStyleItalic">S&#46; aureus</span> screening and decolonization programme in total arthroplasties of the hip and total arthroplasties of the knee in terms of their ability to detect and decolonize&#44; evaluating the incidence of infection in comparison with a historical cohort&#46; It also finally assesses its economic feasibility&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">A study of the intervention was undertaken in comparison with a historical cohort of patients operated for TKA and THA in our hospital in 2019 and 2021&#46; The year 2020 was excluded due to major dysfunctions in the hospital&#44; the department and circuits caused by the COVID-19 pandemic&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">This study was approved by the Research and Medication Ethics Committee &#40;CEIM&#41; of our hospital&#44; with the code CEIC-2606&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The &#8220;Declaration of the Initiative Strengthening the Reporting of Observational studies in Epidemiology &#40;STROBE&#41;&#58; guidelines for the communication of observational studies&#8221; was followed&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Anonymized data and variables are collected prospectively from a database created within the context of an &#8220;Enhanced Recovery After Surgery &#40;ERAS&#41;&#8221;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> programme that has been applied since 2015 for the purpose of collecting data for analysis and continuous improvement&#46; The variables recorded within the framework of this programme are&#58; demographic data&#44; average duration of hospitalization&#44; transfusions&#44; pain and analgesic rescues&#44; screening for <span class="elsevierStyleItalic">S&#46; aureus</span> and complications&#46; Follow-up takes the form of a check-up at 90 days within the framework of the Catalonian infection monitoring programme &#40;VINCAT&#41;&#44; which involves the follow-up of at least the first 100 procedures performed every year&#59; nevertheless&#44; in our hospital active monitoring was expanded to include all arthroplasty surgery after 90 days&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All of the patients operated for primary TKA and THA in 2019 and 2021 for any diagnosis except femur fracture were eligible&#59; septic or aseptic revision surgery was also excluded&#46; The intervention group consisted of the patients operated from 1 January 2021 to 31 December 2021&#44; who were subjected to the <span class="elsevierStyleItalic">S&#46; aureus</span> screening and decolonization protocol&#59; the control group consisted of the patients operated from 1 to 31 December 2019&#44; when the said protocol was not applied&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The screening and decolonization protocol consists of the following steps&#58; a request for a nasal swab for <span class="elsevierStyleItalic">S&#46; aureus</span> is included as routine in the preoperative arthroplasty study for all of the patients in the orthopaedic and traumatology surgery department&#46; The sample is taken in the primary medical care centre using a nasal swab at the same time as the preoperative analytical sample is taken&#44; from 4 to 6 weeks prior to the operation&#46; The result of the swab is examined in the preoperative anaesthesiology meeting&#58; if the result is positive for <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;MSSA or MRSA&#41;&#44; the anaesthesiologist prescribes decolonization treatment with topical mupirocin every 8<span class="elsevierStyleHsp" style=""></span>h during 5 days in the patient&#39;s home&#44; commencing 10 days before the operation&#59; this complies with the time limit described in the literature&#44; which states that surgery should be performed within 3 weeks of decolonization&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> while offering the opportunity of remaining within the time limit if surgery is reprogrammed&#46; The anaesthesiologist requests a follow-up swab after the decolonization treatment and prior to the surgery&#44; and this swab too is performed by primary care&#46; The <span class="elsevierStyleItalic">Unidad Territorial de Infecci&#243;n Nosocomial</span> &#40;UTIN&#41; and antibiotic policy reviews the result of the follow-up swab after the treatment&#46; If the culture taken after the treatment is still positive for MRSA on the day of the intervention&#44; the UTIN will warn the head of surgery and anaesthesiology so that they apply measures from the start of the process&#58; antibiotic prophylaxis will be required&#44; with 1<span class="elsevierStyleHsp" style=""></span>g intravenous vancomycin in a single preoperative dose from 120 to 60<span class="elsevierStyleHsp" style=""></span>min before the incision&#44; contact measures during the whole surgical process and a second decolonization treatment 5&#8211;10 days later with mupirocin or fusidic acid&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The other measures applied to prevent infection were the same in both cohorts&#46; The most notable measures include bathing using neutral soap in the home the day before surgery&#44; and washing the zone to be operated with chlorhexidine soap by hospital staff on entry into the surgical area&#46; The antibiotic prophylaxis protocol consists of a single preoperative dose of 2<span class="elsevierStyleHsp" style=""></span>g intravenous cefazolin&#44; except for patients who are allergic to penicillin&#44; who receive 600<span class="elsevierStyleHsp" style=""></span>mg teicoplanin&#46; The surgical asepsis protocol&#44; maintenance of normal temperature and glycaemia levels are the same for both groups&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The study variables recorded for both groups were&#58; the joint that was operated&#44; age&#44; laterality&#44; sex&#44; ASA&#44; infection of the surgical site 90 days after surgery&#44; type of infection and the germ which caused it&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the intervention group the application of the <span class="elsevierStyleItalic">S&#46; aureus</span> detection culture was evaluated&#44; together with its result and&#44; if it were positive&#44; its type &#40;MRSA or MSSA&#41;&#59; the decolonization treatment performed&#44; the post-decolonization culture and its result&#59; the 3-week period between the post-decolonization culture and surgery&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Data were gathered from three different sources&#46; Firstly&#44; the anonymized database of the ERAS programme was used to obtain the demographic variables and the data on the <span class="elsevierStyleItalic">S&#46; aureus</span> detection culture and its result&#46; Secondly&#44; electronic clinical histories were used for the decolonization treatment data&#44; the result of the post-decolonization culture and the data it was carried out&#46; Lastly&#44; the VINCAT programme database was used to detect the presence of infection after 90 days&#44; the type of infection and the germ which caused it&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The variables are described as medians &#40;interquartile range&#41; or percentages&#46; The Mann&#8211;Whitney test was used to compare the groups &#40;with no normal distribution according to the Kolmogorov&#8211;Smirnov test&#41; for continuous variables&#44; and the Chi-squared test for categorical variables&#46; The level of significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46; Version 23&#46;0 of the SPSS&#174; software was used for calculations &#40;SPSS&#44; Chicago&#44; Ill&#44; USA&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The following direct costs were assumed for the economic analysis&#58; the nasal swab to detect <span class="elsevierStyleItalic">S&#46; aureus</span> costs 4&#46;66&#8364; according to the price set by the <span class="elsevierStyleItalic">Instituto Catal&#225;n de la Salud</span> &#40;ICS&#41;&#44; including the swab&#44; the laboratory technique and labour&#59; 20<span class="elsevierStyleHsp" style=""></span>mg&#47;g mupirocin cream costs 7&#46;51&#8364;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Any possible indirect costs are insignificant&#44; as the patient&#39;s own health centre carries out the analysis at the same time as the preoperative analytical sample is taken&#44; so that no extra travel&#44; consumption or time is involved&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">The initial eligible population consisted of 852 patients who had been operated for TKA or THA in 2019 and 2021 &#40;459 in the historic cohort of 2019 and 393 in the 2021 intervention group&#41;&#46; 89 patients were lost &#40;48 and 41&#44; respectively&#41;&#44; due to problems with their identification and registration in the database&#46; The complete analyzed sample therefore amounted to 763 patients&#58; 411 in the historic cohort and 352 in the intervention cohort &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The sample obtained had a median age of 71 years &#40;64&#8211;78&#41;&#44; with 53&#46;2&#37; women and right laterality in 52&#46;9&#37; of cases&#46; The predominant surgical risk level was ASA II&#46; The surgical operation consisted of TKA in 66&#46;3&#37; of cases &#40;68&#46;9&#37; in 2019 and 63&#46;4&#37; in 2021&#41; and THA in 33&#46;7&#37; of cases &#40;31&#46;1&#37; and 36&#46;8&#37;&#44; respectively&#41;&#46; No statistically significant differences were found between the characteristics of both groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Teicoplanin was given under protocol to patients who were allergic to penicillin&#46; This glycopeptide may affect the prevalence of S&#46; <span class="elsevierStyleItalic">aureus</span> infection&#46; 7&#46;79&#37; of patients were given teicoplanin in the control group&#44; and the corresponding percentage for the intervention group was 7&#46;1&#37;&#44; without any significant differences between both groups &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;1573&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In the intervention group&#58; screening was performed in 89&#37; of cases&#44; and it was positive for <span class="elsevierStyleItalic">S&#46; aureus</span> in 19 cases &#40;8 MRSA and 11 MSSA&#41;&#46; No differences were observed in the demographic characteristics of the screened patients and those who were not screened &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Treatment was confirmed in 18 of the patients with a positive culture&#44; and the follow-up culture was performed within the 3-week interval before surgery in 14&#59; all of them were found to be decolonized&#44; so that no additional measures were necessary during the surgical process&#46; No patient with a positive detection culture suffered infection of the surgical site&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Of the five remaining patients&#44; in one case it was impossible to confirm whether the patient had received the treatment with mupirocin correctly&#59; this was a case of colonization by MSSA&#44; so that the usual prophylaxis with cefazolin was applied&#46; Although the treatment was confirmed in the other 4 cases&#44; this was no so for the post-treatment culture&#46; Three of these cases were found to be colonized by MSSA and received the usual treatment&#44; and the other case of colonization by MRSA was treated prior to surgery with vancomycin and isolated from contact in the hospital ward until a negative swab was obtained&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">One patient with a negative detection culture had an infection of the deep surgical site by <span class="elsevierStyleItalic">S&#46; epidermidis&#46;</span> This was treated by debridement&#44; antibiotics and retention of the implant&#44; with a good result&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Three patients in the historical cohort group suffered deep surgical site infection&#58; one by <span class="elsevierStyleItalic">S&#46; epidermidis</span>&#44; which required debridement with retention of the implant and antibiotic therapy&#59; one by <span class="elsevierStyleItalic">E&#46; cloacae</span>&#44; which was treated by exchange in 2 acts&#44; with relapse of the infection and finally arthrodesis&#59; lastly&#44; there was one case of infection by MSSA <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; which was resolved by revision surgery in 2 acts&#46; One other case in the historical cohort suffered dehiscence of the wound that was resolved by debridement&#44; with a positive culture for MSSA <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; so that it was classified as a superficial infection&#46; These findings were found to lack statistical significance by a Chi-squared test&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Respecting the economic analysis&#44; considering that 312 patients were screened&#44; of whom 19 positive patients were treated&#44; with mupirocin treatment confirmed in 18 of them&#44; and with a test after decolonization treatment in 14 patients before surgery&#44; the cost of the programme amounted to &#8364;1661&#46;85<span class="elsevierStyleHsp" style=""></span>&#40;312<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4&#46;66&#8364;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>19<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&#46;51&#8364;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#8364;4&#46;66&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">On the other hand&#44; the cost&#47;effectiveness of detecting a <span class="elsevierStyleItalic">S&#46; aureus</span> carrier amounts to &#8364;76&#46;5<span class="elsevierStyleHsp" style=""></span>&#40;312<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#8364;4&#46;66&#47;19&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Inferring the intention to treat&#44; including unscreened and lost patients&#44; the cost of screening in the intervention group would have been 1831&#46;38&#8364; &#40;393<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4&#46;66&#8364;&#41;&#44; after which the cost of treatment and the follow-up culture would have to be added&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">S&#46; aureus</span> screening and decolonization programme screened 89&#37; of the patients&#46; 13&#37; of the patients were found to be colonized with <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; and the majority of these were confirmed to have been decolonized&#46; None of the group of screened patients suffered surgical infection by <span class="elsevierStyleItalic">S&#46; aureus</span> or any other germ&#46; Compared with a historical cohort&#44; infections of the prosthesis by any germ were reduced from three to one&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">This study has limitations&#46; The first of these refers to its design&#44; as in studies of historical cohorts&#44; errors due to confusion factors and distortions&#44; such as the varying incidence of infections from one year to another&#44; are more common than they are in prospective studies&#46; The losses during follow-up amounted to 10&#46;4&#37;&#44; without reaching the limit of 20&#37; defined in the literature as a high rate of loss&#59; moreover&#44; the causes of loss of follow-up were the same in both groups&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Although the follow-up time used of 90 days is the same as the one used in certain publications<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;23</span></a> to evaluate infection&#44; this criterion is also used to determine cases of re-hospitalization&#44; and it may be suitable to increase the duration of follow-up to one or 2 years in a subsequent review&#46; Lastly&#44; the 2021 cohort was compared with the one in 2019 because of the major impact of the SARS-CoV-19 pandemic on the health system in 2020&#44; so that it was impossible to implement follow-up protocols or gather data during that year for <span class="elsevierStyleItalic">S&#46; aureus</span> colonization and other factors&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleItalic">S&#46; aureus</span> screening and decolonization programmes are recommended in several protocols&#44; this is usually optional&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24&#8211;27</span></a> The reasons for this are the lack of high-level scientific evidence and the logistical difficulties of implementation&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Our hospital is located in a predominantly rural province and health catchment area&#44; so that it has the challenge of covering a large area for medical care with a low population density&#44; offering service to five regions with towns up to 65<span class="elsevierStyleHsp" style=""></span>km away from the hospital&#46; However&#44; by using a protocol based on obtaining samples in different primary care health centres it was possible to screen 89&#37; of the patients&#46; This percentage is similar to the figures reported in other studies&#44; which screened from 79&#37;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> to even 91&#46;8&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The prevalence of <span class="elsevierStyleItalic">S&#46; aureus</span> carriers in the intervention group amounted to 13&#37;&#44; which is lower than the 30&#37; reported in other series<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8</span></a> and the 20&#37;&#8211;30&#37; of the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Regarding methicillin resistance&#44; eight cases of MRSA were reported&#44; accounting for 42&#46;1&#37;&#44; and 11 cases of MSSA at 57&#46;9&#37;&#46; This rate differs from that in the series such as the one by Sousa et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> which report 96&#46;5&#37; MSSA and 3&#46;5&#37; MRSA&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Colonized patients were treated with nasal mupirocin according to guidelines&#46; This treatment has minimum side effects and there is long experience with using it&#46; It was also associated with previous screening&#44; so that treatment was selective and thereby reduce possible side effects and possible antibiotic resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> There are other decolonization strategies&#44; such as the routine treatment of all patients with mupirocin&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;22</span></a> although these may have negative repercussions in terms of costs and antibiotic resistance&#46; Routine decolonization is also possible using pharmaceutical antiseptic agents&#44; although these may have disadvantages such as difficulty in accessing and preparing them in all centres&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">After treatment it is important to confirm decolonization with a follow-up culture within the 3 weeks prior to surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> This was achieved in our study in 74&#37; of cases &#40;14&#47;19&#41;&#59; no follow-up culture was obtained in the other cases&#46; This datum is lower than those reported in other studies such as the one by Kalmeijer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> which reported 83&#46;5&#37; confirmation of decolonization&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The prevalence of infection of the prosthesis in the intervention group was 0&#46;28&#37;&#44; while in the historical cohort it was 0&#46;72&#37;&#59; these figures are lower than those reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;6</span></a> Furthermore&#44; <span class="elsevierStyleItalic">S&#46; epidermidis</span> was the micro-organism which caused the only infection in the intervention group&#44; unlike <span class="elsevierStyleItalic">S&#46; aureus</span> which is described in the literature in up to 60&#37; of occasions&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;8</span></a> and in 33&#37; of our historical cohort&#46; The low rate of infection of the prosthesis which is reported&#44; with a majority of infections by <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; even in the historical cohort&#44; means that a very high number of patients would be necessary to detect significant differences in terms of a reduction in infections after the application of the decolonization programme&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Therefore&#44; and in spite of not achieving statistical significance in a Chi-squared test&#44; the eradication of the status of being a <span class="elsevierStyleItalic">S&#46; aureus</span> carrier by means of the treatment led to a lower incidence of infection in the surgical site&#44; by <span class="elsevierStyleItalic">S&#46; aureus</span> as well as other germs&#44; in comparison with a historical cohort with statistically comparable basal characteristics&#46; According to the literature&#44; implementing <span class="elsevierStyleItalic">S&#46; aureus</span> decolonization programmes may reduce infections of the prosthesis by all types of germs&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;23</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">With the variables that were used no factors which could be used to identify possible carriers were found&#46; It therefore seems advisable to test all patients who are candidates for prosthetic surgery&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">It may be asked whether these programmes could be recommended in general&#44; or if a study on the incidence of <span class="elsevierStyleItalic">S&#46; aureus</span> infection would be necessary in each individual hospital before applying decolonization protocols&#59; this would have the purpose of identifying infection rates that justify the possible benefits of applying these protocols&#46; In the case of hospitals with a low rate of prosthesis infections in general and more specifically by <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; it could be asked whether the multidisciplinary effort and the difficulty of applying protocols of this type would justify their application&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Nevertheless&#44; the authors consider that while a properly established protocol which is included in the clinical routine of patients&#44; such as the one presented here&#44; does not involve high logistical and economic costs&#44; it does provide benefits&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">There is discussion about the economic implications of programmes of this type&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;22&#44;23&#44;29&#44;30</span></a> Their direct costs are easy to ascribe&#44; although indirect costs must also be taken into account&#44; as they may exist in the form of&#58; the time spent by doctors and the multidisciplinary teams on designing and implementing the protocol&#44; the time take by anaesthesia to check the patients and identify the ones who are positive so that they can be treated&#44; and the time taken by the prevention team in checking those patients who had been positive&#44; after they had received treatment to check the decolonization&#46; In our case these costs were considered to be minimum&#44; as the time taken to design protocols did not reduce the time spent by the group on providing care&#46; Carriers were identified in the same pre-anaesthesia visit when other activities took place&#44; and the prevention team undertook the follow-up during their usual work hours&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">In the light of the calculated costs&#44; the programme may be deduced to be economically viable&#44; given that its direct costs amount to only &#8364;1661&#46;85&#46; Although the reduction in infections was not found to be statistically significant&#44; the said costs may be considered to be far less than those arising from revision surgery of total knee arthroplasty &#40;&#36;24&#44;027 in one act or &#36;38&#44;109 in 2 acts&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> or total hip arthroplasty &#40;&#8364;31&#44;133<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9733 or &#8364;54&#44;098<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;700 in 2 acts&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0240" class="elsevierStylePara elsevierViewall">The implementation of a <span class="elsevierStyleItalic">S&#46; aureus</span> screening and decolonization programme in primary prosthetic surgery of the hip and knee is useful in detecting and decolonizing patients who are colonized by <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; with low costs and the advantage of selective treatment targeting&#46; Implementing these programmes in the context of a protocol for the prevention of surgical infection by <span class="elsevierStyleItalic">S&#46; aureus</span> or other germs avoids the impact of this on patient quality of life as well as in economic terms&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Level of evidence</span><p id="par0245" class="elsevierStylePara elsevierViewall">Level of evidence II&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0250" class="elsevierStylePara elsevierViewall">This work was financed by the Orthopaedic and Traumatology Surgery department of the Hospital Universitario de Santa Maria&#44; through the <span class="elsevierStyleGrantSponsor" id="gs1"><span class="elsevierStyleItalic">Institut de Recerca Biom&#232;dica de Lleida&#44; Fundaci&#243; privada Dr&#46; Pifarr&#233;</span></span>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span><span id="sec1065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1125">Right to privacy and informed consent</span><p id="par1240" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from the patients and&#47;or subjects referred to in the article&#46; This document is held by the corresponding author&#46;</p></span><span id="sec1070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1130">Ethics Committee</span><p id="par00245" class="elsevierStylePara elsevierViewall">Approved by Comit&#232; d&#8217;&#200;tica d&#8217;Investigaci&#243; amb Medicaments&#44; Hospital Universitari Arnau de Vilanova Lleida Registration number&#58; CEIC-2606&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:16 [
        0 => array:3 [
          "identificador" => "xres2130317"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1809177"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2130316"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1809178"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Level of evidence"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflict of interests"
        ]
        12 => array:2 [
          "identificador" => "sec1065"
          "titulo" => "Right to privacy and informed consent"
        ]
        13 => array:2 [
          "identificador" => "sec1070"
          "titulo" => "Ethics Committee"
        ]
        14 => array:2 [
          "identificador" => "xack739238"
          "titulo" => "Acknowledgements"
        ]
        15 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-06-19"
    "fechaAceptado" => "2022-11-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1809177"
          "palabras" => array:5 [
            0 => "Decolonization"
            1 => "Screening"
            2 => "<span class="elsevierStyleItalic">Staphylococcus aureus</span>"
            3 => "Surgical site infection"
            4 => "Total joint arthroplasty"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1809178"
          "palabras" => array:5 [
            0 => "Descolonizaci&#243;n"
            1 => "Cribado"
            2 => "<span class="elsevierStyleItalic">Staphylococcus aureus</span>"
            3 => "Infecci&#243;n del sitio quir&#250;rgico"
            4 => "Artroplastia total"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Detection and decolonization of <span class="elsevierStyleItalic">Staphylococcus aureus</span> prior to surgery is postulated as an option to reduce the risk of infection in arthroplasties&#46; The aim of this study was to evaluate the effectiveness of a screening programme for <span class="elsevierStyleItalic">S&#46; aureus</span> in total knee arthroplasty &#40;TKA&#41; and total hip arthroplasty &#40;THA&#41;&#44; the incidence of infection with respect to a historical cohort&#44; and its economic viability&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pre-post intervention study in patients undergoing primary knee and hip prostheses in 2021&#44; a protocol was carried out to detect nasal colonization by <span class="elsevierStyleItalic">S&#46; aureus</span> and eradication if appropriate&#44; with intranasal mupirocin&#44; post-treatment culture with results three weeks between post-treatment culture and surgery&#46; Efficacy measures are evaluated&#44; costs are analyzed and the incidence of infection is compared with respect to a historical series of patients operated on between January and December 2019&#44; performing a descriptive and comparative statistical analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The groups were statistically comparable&#46; Culture was performed in 89&#37;&#44; with 19 &#40;13&#37;&#41; positive patients&#46; Treatment was confirmed in 18&#44; control culture in 14&#44; all decolonized&#59; none suffered infection&#46; One culture-negative patient suffered from <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> infection&#46; In historical cohort&#58; three suffered deep infection by <span class="elsevierStyleItalic">S&#46; epidermidis</span>&#44; <span class="elsevierStyleItalic">Enterobacter cloacae</span>&#44; <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#46; The cost of the programme is &#8364;1661&#46;85&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The screening programme detected 89&#37; of the patients&#46; The prevalence of infection in the intervention group was lower than in the cohort&#44; with <span class="elsevierStyleItalic">S&#46; epidermidis</span> being the main micro-organism&#44; different from <span class="elsevierStyleItalic">S&#46; aureus</span> described in the literature and in the cohort&#46; We believe that this programme is economically viable&#44; as its costs are low and affordable&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La detecci&#243;n y descolonizaci&#243;n del <span class="elsevierStyleItalic">Staphylococcus aureus</span> previo a la cirug&#237;a&#44; se postula como la opci&#243;n para disminuir el riesgo de infecci&#243;n en artroplastias&#46; El objetivo de este estudio fue evaluar la efectividad de un programa de cribado de <span class="elsevierStyleItalic">S&#46; aureus</span> en la artroplastia total de rodilla &#40;ATR&#41; y en la artroplastia total de cadera &#40;ATC&#41;&#44; la incidencia de infecci&#243;n respecto a una cohorte hist&#243;rica y su viabilidad econ&#243;mica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio pre-postintervenci&#243;n en pacientes intervenidos de ATR y ATC en al a&#241;o 2021&#46; Se realiz&#243; protocolo de detecci&#243;n de colonizaci&#243;n nasal por <span class="elsevierStyleItalic">S&#46; aureus</span> y erradicaci&#243;n si proced&#237;a&#44; con mupirocina intranasal&#44; cultivo postratamiento con el resultado de 3 semanas entre cultivo postratamiento y cirug&#237;a&#46; Se eval&#250;an medidas de eficacia&#44; se analizan costes y se comprara la incidencia de infecci&#243;n respecto a una serie hist&#243;rica de pacientes intervenidos entre enero y diciembre de 2019&#44; realizando an&#225;lisis estad&#237;stico descriptivo y comparativo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los grupos fueron comparables estad&#237;sticamente&#46; Se realiz&#243; el cultivo en el 89&#37;&#44; siendo 19 &#40;13&#37;&#41; pacientes positivos&#46; Se confirm&#243; el tratamiento en 18&#44; cultivo control en 14&#44; todos descolonizados&#59; ninguno sufri&#243; infecci&#243;n&#46; Un paciente con cultivo negativo sufri&#243; infecci&#243;n por <span class="elsevierStyleItalic">S&#46; epidermidis</span>&#46; En cohorte hist&#243;rica&#58; 3 sufrieron infecci&#243;n profunda por <span class="elsevierStyleItalic">S&#46; epidermidis</span>&#44; <span class="elsevierStyleItalic">E&#46; cloacae</span> y <span class="elsevierStyleItalic">S&#46; aureus</span>&#46; El coste del programa fue de 1&#46;661&#44;85&#8364;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El programa de cribado detect&#243; el 89&#37; de los pacientes&#46; La prevalencia de infecci&#243;n en el grupo intervenci&#243;n era menor que en la cohorte&#44; siendo <span class="elsevierStyleItalic">S&#46;</span><span class="elsevierStyleItalic">epidermidis</span> el microorganismo causante&#44; diferente a <span class="elsevierStyleItalic">S&#46; aureus</span> descrito en la literatura y en la cohorte&#46; Consideramos que este programa es econ&#243;micamente viable&#44; siendo sus costes reducidos y asumibles&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1824
            "Ancho" => 2508
            "Tamanyo" => 290362
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Results in a historical cohort and an intervention group&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ASA&#58; classification according to American Society of Anesthesiologists guides&#59; <span class="elsevierStyleItalic">P</span>-value&#58; resulting from the Chi-squared or Mann&#8211;Whitney tests&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Values are expressed as a percentage or median &#40;interquartile range&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">All<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>763&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>411&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2021<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;64&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;64&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;63&#8211;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#62;70 years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex &#40;&#37; men&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;919&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Arthroplasty</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Knee&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hip&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laterality &#40;right&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;814&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ASA</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3511726.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics of the patients who received a prosthetic joint in the years 2019 and 2021 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>763&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ASA&#58; classification according to American Society of Anesthesiologists guides&#59; <span class="elsevierStyleItalic">P</span>-value&#58; resulting from the Chi-squared or Mann&#8211;Whitney tests&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Values are expressed as a percentage or median &#40;interquartile range&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Screened<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Not screened<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;63&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;62&#8211;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;857&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#62;70 years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;690&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex &#40;&#37; men&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;690&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Arthroplasty</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Knee&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hip&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laterality &#40;right&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;778&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ASA</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;522&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3511727.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics of the patients who received a prosthetic joint in the year 2021&#46; According to screening application &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>352&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preoperative chlorhexidine reduces the incidence of surgical site infections in total knee and hip arthroplasty&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Cai"
                            1 => "K&#46; Xu"
                            2 => "W&#46; Hou"
                            3 => "Z&#46; Yang"
                            4 => "P&#46; Xu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Int J Surg"
                        "fecha" => "2017"
                        "volumen" => "39"
                        "paginaInicial" => "221e228"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prosthetic joint infection update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Beam"
                            1 => "D&#46; Osmon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Infect Dis Clin"
                        "fecha" => "2018"
                        "volumen" => "32"
                        "paginaInicial" => "843e859"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost of septic and aseptic revision total knee arthroplasty&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Okafor"
                            1 => "B&#46; Hodgkinson"
                            2 => "S&#46; Nghiem"
                            3 => "C&#46; Vertullo"
                            4 => "J&#46; Byrnes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12891-021-04597-8"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Musculoskelet Disord"
                        "fecha" => "2021"
                        "volumen" => "22"
                        "paginaInicial" => "706"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34407779"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total hip arthroplasty revision due to infection&#58; a cost analysis approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Klouche"
                            1 => "E&#46; Sariali"
                            2 => "P&#46; Mampudy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rcot.2010.02.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Orthop Traumatol Surg Res"
                        "fecha" => "2010"
                        "volumen" => "96"
                        "paginaInicial" => "124"
                        "paginaFinal" => "132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20417910"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative and modifiable risk factors for periprosthetic joint infections &#40;PJI&#41; and recommended guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46;K&#46; Alamanda"
                            1 => "B&#46;D&#46; Springer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12178-018-9494-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Rev Musculoskelet Med"
                        "fecha" => "2018"
                        "volumen" => "11"
                        "paginaInicial" => "325"
                        "paginaFinal" => "331"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29869135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preoperative <span class="elsevierStyleItalic">Staphylococcus aureus</span> screening&#47;decolonization protocol before total joint arthroplasty &#8211; results of a small prospective randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;J&#46; Sousa"
                            1 => "P&#46;M&#46; Barreira"
                            2 => "P&#46;T&#46; Leite"
                            3 => "A&#46;C&#46; Santos"
                            4 => "M&#46;H&#46; Ramos"
                            5 => "A&#46;F&#46; Oliveira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2015.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2016"
                        "volumen" => "31"
                        "paginaInicial" => "234"
                        "paginaFinal" => "239"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26362785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical site infections in orthopedic surgery&#58; the effect of mupirocin nasal ointment in a double-blind&#44; randomized&#44; placebo-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;D&#46; Kalmeijer"
                            1 => "H&#46; Coertjens"
                            2 => "P&#46;M&#46; van Nieuwland-Bollen"
                            3 => "D&#46; Bogaers&#8211;Hofman"
                            4 => "G&#46;A&#46; de Baere"
                            5 => "A&#46; Stuurman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/341025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2002"
                        "volumen" => "35"
                        "paginaInicial" => "353"
                        "paginaFinal" => "358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12145715"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for <span class="elsevierStyleItalic">Staphylococcus aureus</span> nasal colonization in joint arthroplasty patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;L&#46; Walsh"
                            1 => "A&#46;C&#46; Fields"
                            2 => "J&#46;D&#46; Dieterich"
                            3 => "D&#46;D&#46; Chen"
                            4 => "M&#46;J&#46; Bronson"
                            5 => "C&#46;S&#46; Moucha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2017.12.038"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2018"
                        "volumen" => "33"
                        "paginaInicial" => "1530"
                        "paginaFinal" => "1533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29395724"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Periprosthetic joint infection&#58; the economic impact of methicillin-resistant infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Parvizi"
                            1 => "I&#46;M&#46; Pawasarat"
                            2 => "K&#46;A&#46; Azzam"
                            3 => "A&#46; Joshi"
                            4 => "E&#46;N&#46; Hansen"
                            5 => "K&#46;J&#46; Bozic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2010.04.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2010"
                        "volumen" => "25"
                        "paginaInicial" => "103"
                        "paginaFinal" => "107"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20570103"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relation between nasal carriage of <span class="elsevierStyleItalic">Staphylococcus aureus</span> and surgical site infection in orthopedic surgery&#58; the role of nasal contamination&#46; A systematic literature review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;Y&#46; Levy"
                            1 => "M&#46; Ollivier"
                            2 => "M&#46; Drancourt"
                            3 => "D&#46; Raoult"
                            4 => "J&#46;N&#46; Argenson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Orthop Traumatol Surg Res"
                        "fecha" => "2013"
                        "volumen" => "99"
                        "paginaInicial" => "645e651"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is preoperative staphylococcal decolonization efficient in total joint arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;M&#46; Moroski"
                            1 => "S&#46; Woolwine"
                            2 => "R&#46; Schwarzkopf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2014.10.017"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2015"
                        "volumen" => "30"
                        "paginaInicial" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25453634"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nasal decontamination for the prevention of surgical site infection in <span class="elsevierStyleItalic">Staphylococcus aureus</span> carriers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Z&#46; Liu"
                            1 => "G&#46; Norman"
                            2 => "Z&#46; Iheozor-Ejiofor"
                            3 => "J&#46;K&#46; Wong"
                            4 => "E&#46;J&#46; Crosbie"
                            5 => "P&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD012462.pub2"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2017"
                        "volumen" => "5"
                        "paginaInicial" => "CD012462"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28516472"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of two PCR-based methods and conventional culture for the detection of nasal carriage of <span class="elsevierStyleItalic">Staphylococcus aureus</span> in pre-operative patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;I&#46; Andriesse"
                            1 => "M&#46; van Rijen"
                            2 => "D&#46; Bogaers"
                            3 => "A&#46;M&#46;C&#46; Bergmans"
                            4 => "J&#46;A&#46;J&#46;W&#46; Kluytmans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10096-009-0770-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Microbiol Infect Dis"
                        "fecha" => "2009"
                        "volumen" => "28"
                        "paginaInicial" => "1223"
                        "paginaFinal" => "1226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19562391"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Underestimation of <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;MRSA and MSSA&#41; carriage associated with standard culturing techniques&#58; one third of carriers missed"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;T&#46; Tsang"
                            1 => "M&#46;P&#46; McHugh"
                            2 => "D&#46; Guerendiain"
                            3 => "P&#46;J&#46; Gwynne"
                            4 => "J&#46; Boyd"
                            5 => "A&#46;H&#46; Simpson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/2046-3758.71.BJR¿2017-0175.R1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Joint Res"
                        "fecha" => "2018"
                        "volumen" => "7"
                        "paginaInicial" => "79"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29330346"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus&#58;</span> a randomized&#44; placebo-controlled&#44; double-blind clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Wendt"
                            1 => "S&#46; Schinke"
                            2 => "M&#46; W&#252;rttemberger"
                            3 => "K&#46; Oberdorfer"
                            4 => "O&#46; Bock-Hensley"
                            5 => "H&#46; von Baum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/519929"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Control Hosp Epidemiol"
                        "fecha" => "2007"
                        "volumen" => "28"
                        "paginaInicial" => "1036"
                        "paginaFinal" => "1043"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17932823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eradication of methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> carriage&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;S&#46; Ammerlaan"
                            1 => "J&#46;A&#46; Kluytmans"
                            2 => "H&#46;F&#46; Wertheim"
                            3 => "J&#46;L&#46; Nouwen"
                            4 => "M&#46;J&#46; Bonten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/597291"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2009"
                        "volumen" => "48"
                        "paginaInicial" => "922"
                        "paginaFinal" => "930"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19231978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of nasal blood culture isolates of methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> from patients in United States hospitals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;C&#46; Tenover"
                            1 => "I&#46;A&#46; Tickler"
                            2 => "R&#46;V&#46; Goering"
                            3 => "B&#46;N&#46; Kreiswirth"
                            4 => "J&#46;R&#46; Mediavilla"
                            5 => "D&#46;H&#46; Persing"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/AAC.05804-11"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "2012"
                        "volumen" => "56"
                        "paginaInicial" => "1324"
                        "paginaFinal" => "1330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22155818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors associated with mupirocin resistance in meticillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;R&#46; Caffrey"
                            1 => "B&#46;J&#46; Quilliam"
                            2 => "K&#46;L&#46; LaPlante"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhin.2010.06.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Infect"
                        "fecha" => "2010"
                        "volumen" => "76"
                        "paginaInicial" => "206"
                        "paginaFinal" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20846747"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Strengthening the Reporting of Observational Studies in Epidemiology &#40;STROBE&#41;&#58; explanation and elaboration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;P&#46; Vandenbroucke"
                            1 => "E&#46; von Elm"
                            2 => "D&#46;G&#46; Altman"
                            3 => "P&#46;C&#46; G&#248;tzsche"
                            4 => "C&#46;D&#46; Mulrow"
                            5 => "S&#46;J&#46; Pocock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pmed.0040297"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS Med"
                        "fecha" => "2007"
                        "volumen" => "4"
                        "paginaInicial" => "e297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17941715"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus statement for perioperative care in total hip replacement and total knee replacement surgery&#58; Enhanced Recovery After Surgery &#40;ERAS&#174;&#41; Society recommendations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;W&#46; Wainwright"
                            1 => "M&#46; Gill"
                            2 => "D&#46;A&#46; McDonald"
                            3 => "R&#46;G&#46; Middleton"
                            4 => "M&#46; Reed"
                            5 => "O&#46; Sahota"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/17453674.2019.1683790"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Orthop"
                        "fecha" => "2020"
                        "volumen" => "91"
                        "paginaInicial" => "3"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31663402"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Instrumento para la lectura cr&#237;tica y la evaluaci&#243;n de estudios epidemiol&#243;gicos transversales"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Berra"
                            1 => "J&#46; Maria Elorza-Ricart"
                            2 => "M&#46;D&#46; Estrada"
                            3 => "E&#46; S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1157/13126932"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "492"
                        "paginaFinal" => "497"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19000532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decreased hospital costs and surgical site infection incidence with a universal decolonization protocol in primary total joint arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;B&#46; Stambough"
                            1 => "D&#46; Nam"
                            2 => "D&#46;K&#46; Warren"
                            3 => "J&#46;A&#46; Keeney"
                            4 => "J&#46;C&#46; Clohisy"
                            5 => "R&#46;L&#46; Barrack"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2016.09.041"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2017"
                        "volumen" => "32"
                        "paginaInicial" => "728"
                        "paginaFinal" => "734&#46;e1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of preoperative screening and decolonization for <span class="elsevierStyleItalic">Staphylococcus aureus</span> in total joint arthroplasty&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Lin"
                            1 => "Z&#46;Y&#46; Ke"
                            2 => "Y&#46; Wang"
                            3 => "X&#46;L&#46; Chen"
                            4 => "D&#46; Zhong"
                            5 => "S&#46; Cheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.asjsur.2020.12.037"
                      "Revista" => array:5 [
                        "tituloSerie" => "Asian J Endosc Surg"
                        "fecha" => "2021"
                        "volumen" => "44"
                        "paginaInicial" => "807"
                        "paginaFinal" => "818"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Programa de prevenci&#243; de les infeccions quir&#250;rgiques a Catalunya&#58; PREVINQ-CAT"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46; Rams Pla"
                            1 => "I&#46; Davins"
                            2 => "J&#46; Miralles"
                            3 => "F&#46; Gudiol Munt&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2018"
                        "editorial" => "Direcci&#243; general d&#8217;Ordenaci&#243; Professional i Regulaci&#243; Sanit&#224;ria"
                        "editorialLocalizacion" => "Barcelona"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Proyecto de infecci&#243;n quir&#250;rgica zero del SNS&#46; Available at&#58; <a target="_blank" href="https://infeccionquirurgicazero.es/images/stories/recursos/protocolo/2017/3-1-17-documento-Protocolo-IQZ.pdf">https&#58;&#47;&#47;infeccionquirurgicazero&#46;es&#47;images&#47;stories&#47;recursos&#47;protocolo&#47;2017&#47;3-1-17-documento-Protocolo-IQZ&#46;pdf</a> &#91;accessed 25&#46;03&#46;22&#93;&#46;"
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Surgical site infections&#58; prevention and treatment&#58; NICE guideline &#91;NG125&#93;&#46; Available at&#58; <a target="_blank" href="https://www.nice.org.uk/guidance/ng125/informationforpublic">https&#58;&#47;&#47;www&#46;nice&#46;org&#46;uk&#47;guidance&#47;ng125&#47;informationforpublic</a> &#91;accessed 25&#46;03&#46;22&#93;&#46;"
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Diagnosis and prevention of periprosthetic joint infections&#46; Evidence-based clinical practice guideline&#46; Available at&#58; <a target="_blank" href="https://www.aaos.org/globalassets/quality-and-practice-resources/pji/pji-clinical-practice-guideline-final-9-18-19-.pdf">https&#58;&#47;&#47;www&#46;aaos&#46;org&#47;globalassets&#47;quality-and-practice-resources&#47;pji&#47;pji-clinical-practice-guideline-final-9-18-19-&#46;pdf</a> &#91;accessed 25&#46;03&#46;22&#93;&#46;"
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resultados de una intervenci&#243;n de descolonizaci&#243;n de <span class="elsevierStyleItalic">Staphylococcus aureus</span> en pacientes portadores a los que se indica una pr&#243;tesis articular"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Barbero Allende"
                            1 => "J&#46; Romanyk Cabrera"
                            2 => "E&#46; Montero Ruiz"
                            3 => "A&#46; Vall&#233;s Purroy"
                            4 => "V&#46; Melgar Molero"
                            5 => "R&#46; Agudo L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eimc.2014.03.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Infecc Microbiol Clin"
                        "fecha" => "2015"
                        "volumen" => "33"
                        "paginaInicial" => "95"
                        "paginaFinal" => "100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24880651"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of surgical site infections&#58; decontamination with mupirocin based on preoperative screening for <span class="elsevierStyleItalic">Staphylococcus aureus</span> carriers or universal decontamination&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;J&#46; Hetem"
                            1 => "M&#46;C&#46; Bootsma"
                            2 => "M&#46;J&#46; Bonten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/civ990"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2016"
                        "volumen" => "62"
                        "paginaInicial" => "631"
                        "paginaFinal" => "636"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26658054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Burden of surgical site infections associated with arthroplasty and the contribution of <span class="elsevierStyleItalic">Staphylococcus aureus</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Patel"
                            1 => "H&#46; Khoury"
                            2 => "D&#46; Girgenti"
                            3 => "S&#46; Welner"
                            4 => "H&#46; Yu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Surg Infect"
                        "fecha" => "2016"
                        "volumen" => "17"
                        "paginaInicial" => "78e88"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack739238"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0260" class="elsevierStylePara elsevierViewall">The authors would like to thank the following professionals for their collaboration&#58; Dr&#46; Maria Fernanda Ram&#237;rez Hidalgo&#44; for her help in revising the protocol&#59; Dr&#46; Laura Prats&#44; for her collaboration in the revision of the final manuscript&#59; Ms&#46; In&#233;s Ort&#237;z Catalan&#44; hospitalization nurse&#44; Ms&#46; Alba Guitard Quer&#44; UTIN nurse&#44; and Ms&#46; Cristina Cortijo Lecina&#44; surgical patient reception nurse&#44; for their collaboration in data gathering&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/18884415/0000006700000004/v3_202404150749/S1888441523000838/v3_202404150749/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "92787"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales &#47; Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/18884415/0000006700000004/v3_202404150749/S1888441523000838/v3_202404150749/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441523000838?idApp=UINPBA00004N"
]
Article information
ISSN: 18884415
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 3 0 3
2024 October 23 9 32
2024 September 36 14 50
2024 August 26 6 32
2024 July 21 4 25
2024 June 16 8 24
2024 May 22 12 34
2024 April 20 10 30
2024 March 34 2 36
2024 February 15 9 24
2024 January 28 4 32
2023 December 24 13 37
2023 November 35 9 44
2023 October 54 7 61
2023 September 45 5 50
2023 August 30 7 37
2023 July 97 9 106
2023 June 36 5 41
2023 May 68 11 79
2023 April 26 1 27
2023 March 0 2 2
Show all

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos