Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus.
OBJECTIVE
To characterize the epidemiology of severe (ie, nonsuperficial) surgical site infection (SSI) in community hospitals.


METHODS
SSI data were collected prospectively at 26 community hospitals in the southeastern United States. Two analyses were performed: (1) a study of the overall prevalence rates of SSI and the prevalence rates of SSI due to specific pathogens in 2005 at all participating hospitals and (2) a prospective study of consecutive surgical procedures at 9 of the 26 community hospitals from 2000 through 2005.


RESULTS
In 2005, a total of 1,010 SSIs occurred after 89,302 procedures (prevalence rate, 1.13 infections per 100 procedures). Methicillin-resistant S. aureus (MRSA) was the pathogen most commonly recovered (from 175 SSIs). Trend data from 2000 through 2005 demonstrated that the prevalence rate of MRSA SSI almost doubled during this period, increasing from 0.12 infections per 100 procedures (95% confidence interval [CI], 0.12-0.13) to 0.23 infections per 100 procedures (95% CI, 0.22-0.24) (P<.0001). In adjusted analysis, MRSA SSI was significantly more prevalent at the end of the study period than at the beginning (prevalence rate ratio, 1.48 [95% CI, 1.36-1.61]; P<.0001).


CONCLUSIONS
MRSA was the pathogen that most commonly caused SSI in our network of community hospitals during 2005. The prevalence of MRSA SSI has increased significantly over the past 6 years.
Anderson
Deverick J
DJ
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, 27710, USA. deverick.anderson@duke.edu
Sexton
Daniel J
DJ
Kanafani
Zeina A
ZA
Auten
Grace
G
Kaye
Keith S
KS
D003428:Cross Infection / Q000453:epidemiology*; D006764:Hospitals, Community / Q000639:trends*; D006801:Humans; D016106:Methicillin Resistance; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000472:pathogenicity; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology*