Postoperative Staphylococcus aureus infections in patients with and without preoperative colonization
Author
Troeman, Darren P RHazard, Derek
Timbermont, Leen
Malhotra-Kumar, Surbhi
van Werkhoven, Cornelis H
Wolkewitz, Martin
Ruzin, Alexey
Goossens, Herman
Bonten, Marc J M
Harbarth, Stephan
Sifakis, Frangiscos
Kluytmans, Jan A J W
Vlaeminck, Jelle
Vilken, Tuba
Xavier, Basil Britto
Lammens, Christine
van Esschoten, Marjolein
Paling, Fleur P
Recanatini, Claudia
Coenjaerts, Frank
Sellman, Bret
Tkaczyk, Christine
Weber, Susanne
Ekkelenkamp, Miquel Bart
van der Laan, Lijckle
Vierhout, Bastiaan P
Couvé-Deacon, Elodie
David, Miruna
Chadwick, David
Llewelyn, Martin J
Ustianowski, Andrew
Bateman, Antony
Mawer, Damian
Carevic, Biljana
Konstantinovic, Sonja
Djordjevic, Zorana
Del Toro-López, María Dolores
Gallego, Juan Pablo Horcajada
Escudero, Dolores
Rojo, Miquel Pujol
Torre-Cisneros, Julian
Castelli, Francesco
Nardi, Giuseppe
Barbadoro, Pamela
Altmets, Mait
Mitt, Piret
Todor, Adrian
Bubenek-Turconi, Serban-Ion
Corneci, Dan
Sandesc, Dorel
Gheorghita, Valeriu
Brat, Radim
Hanke, Ivo
Neumann, Jan
Tomáš, Tomáš
Laffut, Wim
Van den Abeele, Anne-Marie
Publication date
2023-10-02
Metadata
Show full item recordAbstract
Importance: Staphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies. Objectives: To assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors. Design, setting, and participants: This multicenter cohort study assessed surgical patients at 33 hospitals in 10 European countries who were recruited between December 16, 2016, and September 30, 2019 (follow-up through December 30, 2019). Enrolled patients were actively followed up for up to 90 days after surgery to assess the occurrence of S aureus SSIs and BSIs. Data analysis was performed between November 20, 2020, and April 21, 2022. All patients were 18 years or older and had undergone 11 different types of surgical procedures. They were screened for S aureus colonization in the nose, throat, and perineum within 30 days before surgery (source population). Both S aureus carriers and noncarriers were subsequently enrolled in a 2:1 ratio. Exposure: Preoperative S aureus colonization. Main outcomes and measures: The main outcome was cumulative incidence of S aureus SSIs and BSIs estimated for the source population, using weighted incidence calculation. The independent association of candidate variables was estimated using multivariable Cox proportional hazards regression models. Results: In total, 5004 patients (median [IQR] age, 66 [56-72] years; 2510 [50.2%] female) were enrolled in the study cohort; 3369 (67.3%) were S aureus carriers. One hundred patients developed S aureus SSIs or BSIs within 90 days after surgery. The weighted cumulative incidence of S aureus SSIs or BSIs was 2.55% (95% CI, 2.05%-3.12%) for carriers and 0.52% (95% CI, 0.22%-0.91%) for noncarriers. Preoperative S aureus colonization (adjusted hazard ratio [AHR], 4.38; 95% CI, 2.19-8.76), having nonremovable implants (AHR, 2.00; 95% CI, 1.15-3.49), undergoing mastectomy (AHR, 5.13; 95% CI, 1.87-14.08) or neurosurgery (AHR, 2.47; 95% CI, 1.09-5.61) (compared with orthopedic surgery), and body mass index (AHR, 1.05; 95% CI, 1.01-1.08 per unit increase) were independently associated with S aureus SSIs and BSIs. Conclusions and relevance: In this cohort study of surgical patients, S aureus carriage was associated with an increased risk of developing S aureus SSIs and BSIs. Both modifiable and nonmodifiable etiologic factors were associated with this risk and should be addressed in those at increased S aureus SSI and BSI risk.Citation
Troeman DPR, Hazard D, Timbermont L, Malhotra-Kumar S, van Werkhoven CH, Wolkewitz M, Ruzin A, Goossens H, Bonten MJM, Harbarth S, Sifakis F, Kluytmans JAJW; ASPIRE-SSI Study Team; Vlaeminck J, Vilken T, Xavier BB, Lammens C, van Esschoten M, Paling FP, Recanatini C, Coenjaerts F, Sellman B, Tkaczyk C, Weber S, Ekkelenkamp MB, van der Laan L, Vierhout BP, Couvé-Deacon E, David M, Chadwick D, Llewelyn MJ, Ustianowski A, Bateman A, Mawer D, Carevic B, Konstantinovic S, Djordjevic Z, Del Toro-López MD, Gallego JPH, Escudero D, Rojo MP, Torre-Cisneros J, Castelli F, Nardi G, Barbadoro P, Altmets M, Mitt P, Todor A, Bubenek-Turconi SI, Corneci D, Sandesc D, Gheorghita V, Brat R, Hanke I, Neumann J, Tomáš T, Laffut W, Van den Abeele AM. Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization. JAMA Netw Open. 2023 Oct 2;6(10):e2339793. doi: 10.1001/jamanetworkopen.2023.39793. PMID: 37906196; PMCID: PMC10618839.Type
ArticleAdditional Links
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2811145PMID
37906196Journal
JAMA Network OpenPublisher
American Medical Associationae974a485f413a2113503eed53cd6c53
10.1001/jamanetworkopen.2023.39793