Guidelines for Complications of Cancer Treatment Vol VIII Part B

ate from 2.7% to 1.3%, with a nonsignificant reduction of Saureus surgical site infection from 1.1% to 0.7% 43 . Anotherstudy that used mupirocin in conjunction with preoperativetriclosan shower showed a marked decrease in the incidenceof MRSA surgical site infections from 23 per 1000 operationsto 3.3 to 4 per 1000 operations, after the introduction of amupirocin-based protocol 44 . Although a consensus has notbeen reached regarding the relationship between mupirocinnasal decolonization and the reduction of S aureus surgicalsite infections, identification of patients colonized with MRSAis important, because vancomycin or teicoplanin prophylaxisis indicated for these patients.Optimization of the total joint arthroplasty patientUnlike in a routine Arthroplasty setting, in an Oncology patient,there is not much time to optimise factors such as obesity ornutrition. Most patients are on immunosuppressivechemotherapy. Patients at high risk for infection, such as thosewith rheumatoid arthritis, the elderly, malnourished, obese,diabetic, or otherwise immunosuppressed, may benefit fromthe optimization of these risk factors, or may require moreintensive prophylaxis to minimize their risk of sepsis 25 .1. Patients with preoperative lymphocyte counts of less than1500 cells/mm3 and an albumin level of less than3.5 g/dL had five and seven times more frequent majorwound complications, respectively 45 .2. Glycemic control is desirable in diabetic patientsundergoing elective implant surgery, although no reportsof the effect of normalizing serum glucose levels in thesetting of total hip arthroplasty have been published 7,25 .3. Smoking cessation or abstaining from tobacco is highlyrecommended 7 .130