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 d...

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Autores: Troeman, Darren P. R., Horcajada Gallego, Juan Pablo, Van den Abeele, Anne-Marie
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/68282
Acceso en línea:http://hdl.handle.net/10230/68282
http://dx.doi.org/10.1001/jamanetworkopen.2023.39793
Access Level:acceso abierto
Palabra clave:Estafilococs daurats
Infeccions quirúrgiques
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spelling Postoperative staphylococcus aureus infections in patients with and without preoperative colonizationTroeman, Darren P. R.Horcajada Gallego, Juan PabloVan den Abeele, Anne-MarieEstafilococs dauratsInfeccions quirúrgiquesImportance: 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.This study was supported by grant 115523 from the Innovative Medicines Initiative Joint Undertaking, which was composed of financial contributions from the European Union Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Associations companies in-kind contributiAmerican Medical Association202420242023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/68282http://dx.doi.org/10.1001/jamanetworkopen.2023.39793reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésJAMA Netw Open. 2023 Oct 2;6(10):e2339793info:eu-repo/grantAgreement/EC/FP7/115523© 2023 Troeman DPR et al. JAMA Network Open. This is an open access article distributed under the terms of the CC-BY License (http://creativecommons.org/licenses/by/4.0/).http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/682822026-06-12T07:21:37Z
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.
Estafilococs daurats
Infeccions quirúrgiques
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.
Horcajada Gallego, Juan Pablo
Van den Abeele, Anne-Marie
author Troeman, Darren P. R.
author_facet Troeman, Darren P. R.
Horcajada Gallego, Juan Pablo
Van den Abeele, Anne-Marie
author_role author
author2 Horcajada Gallego, Juan Pablo
Van den Abeele, Anne-Marie
author2_role author
author
dc.subject.none.fl_str_mv Estafilococs daurats
Infeccions quirúrgiques
topic Estafilococs daurats
Infeccions quirúrgiques
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
2024
2024
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 http://hdl.handle.net/10230/68282
http://dx.doi.org/10.1001/jamanetworkopen.2023.39793
url http://hdl.handle.net/10230/68282
http://dx.doi.org/10.1001/jamanetworkopen.2023.39793
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv JAMA Netw Open. 2023 Oct 2;6(10):e2339793
info:eu-repo/grantAgreement/EC/FP7/115523
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv American Medical Association
publisher.none.fl_str_mv American Medical Association
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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