Variation in the type and frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical procedure.
OBJECTIVE
To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.design. Retrospective cohort study.


METHODS
Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia.


METHODS
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.


CONCLUSIONS
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.
Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina 27710, USA. dja@duke.edu
Deverick J
DJ
Anderson
Jean Marie
JM
Arduino
Shelby D
SD
Reed
Daniel J
DJ
Sexton
Keith S
KS
Kaye
Chelsea A
CA
Grussemeyer
Senaka A
SA
Peter
Chantelle
C
Hardy
Yong Il
YI
Choi
Joelle Y
JY
Friedman
Vance G
VG
Fowler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D019637:Orthopedic Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D019616:Thoracic Surgical Procedures / Q000009:adverse effects; D014768:Virginia / Q000453:epidemiology; D055815:Young Adult