Funding

The investigators anticipate that utilization of retapamulin preoperatively will eliminate MRSA colonization among patients who are colonized in their nares.

Enhanced characterization of MRSA strains carried by patients and their eradication prior to surgery will significantly reduce healthcare costs to the VA by reducing the number of MRSA positive patients who need to be isolated and or closely monitored, and allow healthcare providers to better predict the patient's requirements. In addition, the application of molecular methods will facilitate faster tracking of MRSA postoperative infections.

Inclusion Criteria:

• Patients who are admitted for an orthopedic surgical procedure
• All patients will be screened and admitted to the study prior to surgery regardless of eventual culture results for MRSA

Exclusion Criteria:

• Pregnancy
• Serious systemic illness due to renal, cardiac or hepatic disease
• Inability to complete follow-up assessments
• Allergy or intolerance to retapamulin
• BMI > 30
• Uncontrolled diabetes, severe anemia, thrombocytopenia or an underlying hematopoietic disorder or malignancy
• Patients with serious life-threatening illnesses and those with terminal illness not expected to survive for two years or more will not be enrolled
• Antibiotics administered during the course of the study will be recorded (name, dose and dates)