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Multicenter Study
. 2023 Oct 2;6(10):e2339793.
doi: 10.1001/jamanetworkopen.2023.39793.

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Darren P R Troeman  1 , Derek Hazard  2 , Leen Timbermont  3 , Surbhi Malhotra-Kumar  3 , Cornelis H van Werkhoven  1 , Martin Wolkewitz  2 , Alexey Ruzin  4 , Herman Goossens  3 , Marc J M Bonten  1 , Stephan Harbarth  5 , Frangiscos Sifakis  6   7 , Jan A J W Kluytmans  1   8 ; ASPIRE-SSI Study Team; Jelle Vlaeminck  3 , Tuba Vilken  3 , Basil Britto Xavier  3 , Christine Lammens  3 , Marjolein van Esschoten  1 , Fleur P Paling  1 , Claudia Recanatini  1 , Frank Coenjaerts  9 , Bret Sellman  7 , Christine Tkaczyk  7 , Susanne Weber  2 , Miquel Bart Ekkelenkamp  8 , Lijckle van der Laan  10 , Bastiaan P Vierhout  11 , Elodie Couvé-Deacon  12 , Miruna David  13 , David Chadwick  14 , Martin J Llewelyn  15 , Andrew Ustianowski  16 , Antony Bateman  17 , Damian Mawer  18 , Biljana Carevic  19 , Sonja Konstantinovic  20 , Zorana Djordjevic  21 , María Dolores Del Toro-López  22 , Juan Pablo Horcajada Gallego  23   24 , Dolores Escudero  25 , Miquel Pujol Rojo  26 , Julian Torre-Cisneros  24   27 , Francesco Castelli  28 , Giuseppe Nardi  29 , Pamela Barbadoro  30 , Mait Altmets  31 , Piret Mitt  32 , Adrian Todor  33 , Serban-Ion Bubenek-Turconi  34 , Dan Corneci  35 , Dorel Sandesc  36 , Valeriu Gheorghita  37 , Radim Brat  38 , Ivo Hanke  39 , Jan Neumann  40 , Tomáš Tomáš  41 , Wim Laffut  42 , Anne-Marie Van den Abeele  43
Affiliations
Multicenter Study

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Darren P R Troeman et al. JAMA Netw Open. .

Erratum in

  • Error in Author Affiliations.
    [No authors listed] [No authors listed] JAMA Netw Open. 2024 Mar 4;7(3):e244564. doi: 10.1001/jamanetworkopen.2024.4564. JAMA Netw Open. 2024. PMID: 38441902 Free PMC article. No abstract available.

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Van Werkhoven reported receiving research grants/in-kind contribution from DaVolterra, BioMerieux, and Limmatech and consultancy fees from Merck/MSD and Sanofi-Pasteur. Dr Ruzin reported being an employee of AstraZeneca and owner of AstraZeneca stock at the time of study conduct. Dr Sifakis reported being an employee at Gilead Sciences and owner of Gilead Sciences stock and an employee of AstraZeneca and owner of AstraZeneca stock at the time of study conduct. Dr Rojo reported receiving grants from COMBACTE-MAGNET during the conduct of the study. Prof Barbadoro reported receiving grant funding from University Medical Center Utrecht during the conduct of the study. Dr Gallego reported receiving honoraria from Pfizer, Merck Sharp & Dohme, and Gilead outside the submitted work.

Figures

Figure 1.
Figure 1.. Flow of Participants in the Advanced Understanding of Staphylococcus aureus Infections in Europe–Surgical Site Infections (ASPIRE-SSI) Study
Figure 2.
Figure 2.. Cumulative Incidence Function for Staphylococcus aureus Surgical Site Infections (SSIs) and Bloodstream Infections (BSIs) in S aureus Colonized vs Noncolonized Patients
See this image and copyright information in PMC

References

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