Variation in the type and frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical procedure.
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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.
Aged, 80 and over
Cardiac Surgical Procedures
Methicillin-Resistant Staphylococcus aureus
Surgical Procedures, Operative
Surgical Wound Infection
Thoracic Surgical Procedures
Published Version (Please cite this version)10.1086/653205
Publication InfoAnderson, DJ; Arduino, JM; Choi, YI; Fowler, Vance Garrison Jr; Friedman, JY; Grussemeyer, CA; ... Sexton, DJ (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.
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Florence McAlister Distinguished Professor of Medicine
Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia Antibacterial ResistancePathogenesis of Bacterial Infections Tropical medicine/International Health
Professor in Population Health Sciences
Shelby Reed, PhD, RPh is Professor in Population Health Sciences and Medicine at Duke University and Director of the Preference Evaluation Research (PrefER) Group at the Duke Clinical Research Institute. She also is core faculty and serves on the executive committee at the Duke-Margolis Center for Health Policy. Dr. Reed has 20 years of experience leading multidisciplinary health outcomes research studies. Dr. Reed has extensive expertise in designing and conducting trial-based and mode
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