title: Antibiotic Resistance of Commensal Staphylococcus aureus and Coagulase-Negative Staphylococci in an International Cohort of Surgeons: A Prospective Point-Prevalence Study.
abstract: Nasal colonization with antibiotic resistant bacteria represents both a risk factor for the colonized individual and their immediate contacts. Despite the fact that healthcare workers such as orthopedic surgeons are at a critical interface between the healthcare environment and an at-risk patient population, the prevalence of antibiotic resistant bacteria within the surgical profession remains unclear. This study offers a snapshot of the rate of nasal colonization of orthopedic surgeons with multi-resistant staphylococci including methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS). We performed a prospective, observational study obtained at a single time point in late 2013. The participants were active orthopedic, spine and head & neck surgeons from 75 countries. The prevalence of nasal carriage of the different bacteria and the corresponding 95% confidence interval were calculated. From a cohort of 1,166 surgeons, we found an average S. aureus nasal colonization rate of 28.0% (CI 25.4;30.6) and MRSA rate of 2.0% (CI 1.3;2.9), although significant regional variations were observed. The highest rates of MRSA colonization were found in Asia (6.1%), Africa (5.1%) and Central America (4.8%). There was no MRSA carriage detected within our population of 79 surgeons working in North America, and a low (0.6%) MRSA rate in 657 surgeons working in Europe. High rates of MRCoNS nasal carriage were also observed (21.4% overall), with a similar geographic distribution. Recent use of systemic antibiotics was associated with higher rates of carriage of resistant staphylococci. In conclusion, orthopedic surgeons are colonized by S. aureus and MRSA at broadly equivalent rates to the general population. Crucially, geographic differences were observed, which may be partially accounted for by varying antimicrobial stewardship practices between the regions. The elevated rates of resistance within the coagulase-negative staphylococci are of concern, due to the increasing awareness of their importance in hospital acquired and device-associated infection.
authors: Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany.|AO Research Institute, Davos, Switzerland.
authors: Mario
authors: M
authors: Morgenstern
authors: Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany.|AO Research Institute, Davos, Switzerland.
authors: Christoph
authors: C
authors: Erichsen
authors: Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany.|AO Research Institute, Davos, Switzerland.
authors: Simon
authors: S
authors: Hackl
authors: Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany.
authors: Julia
authors: J
authors: Mily
authors: Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany.
authors: Matthias
authors: M
authors: Militz
authors: Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany.
authors: Jan
authors: J
authors: Friederichs
authors: Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany.|Paracelsus Medical University, Salzburg, Austria.
authors: Sven
authors: S
authors: Hungerer
authors: Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany.
authors: Volker
authors: V
authors: Bühren
authors: AO Research Institute, Davos, Switzerland.
authors: T Fintan
authors: TF
authors: Moriarty
authors: AO Research Institute, Davos, Switzerland.
authors: Virginia
authors: V
authors: Post
authors: AO Research Institute, Davos, Switzerland.
authors: R Geoff
authors: RG
authors: Richards
authors: Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America.
authors: Stephen L
authors: SL
authors: Kates
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification; D015995:Prevalence; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000235:genetics / Q000378:metabolism*; D066231:Surgeons