Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

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 de...

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Autores: Troeman, Darren P. R., Hazard, Derek, Timbermont, Leen, Malhotra Kumar, Surbhi, Werkhoven, Cornelis H. van, Wolkewitz, Martin, Ruzin, Alexey, Goossens, Herman, Bonten, Marc J. M., Harbarth, Stephan, Sifakis, Frangiscos, Kluytmans, Jan A. J. W., ASPIRE SSI Study Team
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2023
País:España
Recursos:Universidad de Barcelona
Repositório:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/205248
Acesso em linha:https://hdl.handle.net/2445/205248
Access Level:Acceso aberto
Palavra-chave:Infeccions per estafilococs
Període postoperatori
Staphylococcal infections
Postoperative period
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spelling Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative ColonizationTroeman, Darren P. R.Hazard, DerekTimbermont, LeenMalhotra Kumar, SurbhiWerkhoven, Cornelis H. vanWolkewitz, MartinRuzin, AlexeyGoossens, HermanBonten, Marc J. M.Harbarth, StephanSifakis, FrangiscosKluytmans, Jan A. J. W.ASPIRE SSI Study TeamInfeccions per estafilococsPeríode postoperatoriStaphylococcal infectionsPostoperative periodImportance 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.American Medical Association (AMA)2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/205248Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1001/jamanetworkopen.2023.39793JAMA Network Open, 2023, vol. 6, num. 10, p. e2339793https://doi.org/10.1001/jamanetworkopen.2023.39793cc by (c) Troeman, Darren P. R. et al., 2023http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2052482026-05-27T06:46:51Z
dc.title.none.fl_str_mv Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization
title Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization
spellingShingle Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization
Troeman, Darren P. R.
Infeccions per estafilococs
Període postoperatori
Staphylococcal infections
Postoperative period
title_short Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization
title_full Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization
title_fullStr Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization
title_full_unstemmed Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization
title_sort Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization
dc.creator.none.fl_str_mv Troeman, Darren P. R.
Hazard, Derek
Timbermont, Leen
Malhotra Kumar, Surbhi
Werkhoven, Cornelis H. van
Wolkewitz, Martin
Ruzin, Alexey
Goossens, Herman
Bonten, Marc J. M.
Harbarth, Stephan
Sifakis, Frangiscos
Kluytmans, Jan A. J. W.
ASPIRE SSI Study Team
author Troeman, Darren P. R.
author_facet Troeman, Darren P. R.
Hazard, Derek
Timbermont, Leen
Malhotra Kumar, Surbhi
Werkhoven, Cornelis H. van
Wolkewitz, Martin
Ruzin, Alexey
Goossens, Herman
Bonten, Marc J. M.
Harbarth, Stephan
Sifakis, Frangiscos
Kluytmans, Jan A. J. W.
ASPIRE SSI Study Team
author_role author
author2 Hazard, Derek
Timbermont, Leen
Malhotra Kumar, Surbhi
Werkhoven, Cornelis H. van
Wolkewitz, Martin
Ruzin, Alexey
Goossens, Herman
Bonten, Marc J. M.
Harbarth, Stephan
Sifakis, Frangiscos
Kluytmans, Jan A. J. W.
ASPIRE SSI Study Team
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Infeccions per estafilococs
Període postoperatori
Staphylococcal infections
Postoperative period
topic Infeccions per estafilococs
Període postoperatori
Staphylococcal infections
Postoperative period
description 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.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/205248
url https://hdl.handle.net/2445/205248
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1001/jamanetworkopen.2023.39793
JAMA Network Open, 2023, vol. 6, num. 10, p. e2339793
https://doi.org/10.1001/jamanetworkopen.2023.39793
dc.rights.none.fl_str_mv cc by (c) Troeman, Darren P. R. et al., 2023
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Troeman, Darren P. R. et al., 2023
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv American Medical Association (AMA)
publisher.none.fl_str_mv American Medical Association (AMA)
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.301603

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