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Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure

Published online by Cambridge University Press:  02 January 2015

Deverick J. Anderson ,
Jean Marie Arduino ,
Shelby D. Reed ,
Daniel J. Sexton ,
Keith S. Kaye ,
Chelsea A. Grussemeyer ,
Senaka A. Peter ,
Chantelle Hardy ,
Yong II Choi  and
Joelle Y. Friedman
...Show all authors
Deverick J. Anderson*
Affiliation:
Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina
Jean Marie Arduino
Affiliation:
Merck Research Laboratories, Merck & Co, Inc, North Wales, Pennsylvania
Shelby D. Reed
Affiliation:
Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina Duke Clinical Research Institute, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina
Keith S. Kaye
Affiliation:
Wayne State University, Detroit, Michigan
Chelsea A. Grussemeyer
Affiliation:
Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina
Senaka A. Peter
Affiliation:
Merck Research Laboratories, Merck & Co, Inc, North Wales, Pennsylvania
Chantelle Hardy
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina
Yong II Choi
Affiliation:
Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina
Joelle Y. Friedman
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina
Vance G. Fowler Jr
Affiliation:
Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina Duke Clinical Research Institute, Durham, North Carolina
*
Duke University Medical Center, Box 102359, Durham, NC 27710 (dja@duke.edu)
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Extract

Objective.

To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.

Design.

Retrospective cohort study.

Setting.

Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia.

Patients.

Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures.

Methods.

We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson x2 test, Student t test, or Wilcoxon rank-sum test, as appropriate.

Results.

In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43–0.52); 227 (51%) of 446 infections were due to methicillin-resistant S. aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95% CI, 0.62–0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32–0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53–0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17¬0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43–0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95% CI, 0.42–0.59]; P < .001, compared with other procedure types), comprising 80% of invasive S. aureus infections after these procedures.

Conclusion.

The frequency and type of postoperative invasive S. aureus infection varied significantly across procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for ongoing preventative interventions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 7 , July 2010 , pp. 701 - 709
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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