Variation in the type and frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical procedure.
Abstract
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 chi2 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
Journal articleSubject
AdolescentAdult
Aged
Aged, 80 and over
Bacteremia
Cardiac Surgical Procedures
Cohort Studies
Cross Infection
Female
Hospitals
Humans
Incidence
Male
Methicillin-Resistant Staphylococcus aureus
Middle Aged
North Carolina
Orthopedic Procedures
Postoperative Complications
Retrospective Studies
Staphylococcal Infections
Staphylococcus aureus
Surgical Procedures, Operative
Surgical Wound Infection
Thoracic Surgical Procedures
Virginia
Young Adult
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https://hdl.handle.net/10161/4152Published Version (Please cite this version)
10.1086/653205Publication Info
Anderson, Deverick J; Arduino, Jean Marie; Reed, Shelby D; Sexton, Daniel J; Kaye,
Keith S; Grussemeyer, Chelsea A; ... Fowler, Vance G (2010). Variation in the type and frequency of postoperative invasive Staphylococcus aureus
infections according to type of surgical procedure. Infect Control Hosp Epidemiol, 31(7). pp. 701-709. 10.1086/653205. Retrieved from https://hdl.handle.net/10161/4152.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Deverick John Anderson
Professor of Medicine
Hospital epidemiology, infection control, antibiotic stewardship, multidrug-resistant
organisms, device-related infections, surgical site infections, catheter-associated
bloodstream infections, cost of infections, infections in community hospitals
Vance Garrison Fowler Jr.
Florence McAlister Distinguished Professor of Medicine
Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia Antibacterial
ResistancePathogenesis of Bacterial Infections Tropical medicine/International Health
Shelby Derene Reed
Professor in Population Health Sciences
Shelby D. Reed, PhD, is Professor in the Departments of Population Health Sciences
and Medicine at Duke University’s School of Medicine. She is the director of the
Center for Informing Health Decisions and Therapeutic Area leader for Population Health
Sciences at the Duke Clinical Research Institute (DCRI). She also is core faculty
at the Duke-Margolis Center for Health Policy. Dr. Reed has over 20 years of experience
leading multidisciplinary health outcomes research studie
Daniel John Sexton
Professor Emeritus of Medicine
During the past 8 years my research interests have changed from a focus on tick-borne
disease and endocarditis to a primary focus on healthcare-associated infections (HAIs).
Specifically, I have been interested in HAIs in community hospitals. Using prospective
data collected as part of our surveillance activities in the Duke Infection Control
Outreach Network (DICON), I and my colleagues have focused on these specific areas
of research: • The accuracy and reliability of surveil
Alphabetical list of authors with Scholars@Duke profiles.

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