title: Evaluation of Staphylococcus aureus Eradication Therapy in Vascular Surgery.
abstract: BACKGROUND
  Surgical site infections (SSI) are a serious complication in vascular surgery which may lead to severe morbidity and mortality. Staphylococcus aureus nasal carriage is associated with increased risk for development of SSIs in central vascular surgery. The risk for SSI can be reduced by perioperative eradication of S. aureus carriage in cardiothoracic and orthopedic surgery. This study analyzes the relation between S. aureus eradication therapy and SSI in a vascular surgery population.
  
  
  METHODS
  A prospective cohort study was performed, including all patients undergoing vascular surgery between February 2013 and April 2015. Patients were screened for S. aureus nasal carriage and, when tested positive, were subsequently treated with eradication therapy. The presence of SSI was recorded based on criteria of the CDC. The control group consisted of a cohort of vascular surgery patients in 2010, who were screened, but received no treatment.
  
  
  RESULTS
  A total of 444 patients were screened. 104 nasal swabs were positive for S. aureus, these patients were included in the intervention group. 204 patients were screened in the 2010 cohort. 51 tested positive and were included in the control group. The incidence of S. aureus infection was 5 out of 51 (9.8%) in the control group versus 3 out of 104 in the eradication group (2.2%; 95% confidence interval 0.02-1.39; P = 0.13). A subgroup analysis showed that the incidence of S. aureus infection was 3 out of 23 (13.0%) in the control group in central reconstructive surgery versus 0 out of 44 in the intervention group (P = 0.074). The reduction of infection pressure by S. aureus was stronger than the reduction of infection pressure by other pathogens (exact maximum likelihood estimation; OR = 0.0724; 95% CI: 0.001-0.98; p = 0.0475).
  
  
  CONCLUSIONS
  S. aureus eradication therapy reduces the infection pressure of S. aureus, resulting in a reduction of SSIs caused by S. aureus.
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: J C M
authors.identifier: http://orcid.org/0000-0002-7327-4091
authors.initials: JC
authors.lastname: Langenberg
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: A R
authors.initials: AR
authors.lastname: Thomas
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: J M W
authors.initials: JM
authors.lastname: Donker
authors.affiliation: Laboratory of Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands.
authors.forename: M M L
authors.initials: MM
authors.lastname: van Rijen
authors.affiliation: Laboratory of Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands.|Julius Center for Health Sciences and Primary Care, UMCU, Utrecht, The Netherlands.
authors.forename: J A J W
authors.initials: JA
authors.lastname: Kluytmans
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van der Laan
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009666:Nose / Q000382:microbiology; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification / Q000502:physiology*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*