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J Hosp Infect. 2018 Feb;98(2):118-126. doi: 10.1016/j.jhin.2017.09.025. Epub 2017 Oct 6.

Temporal trends and epidemiology of Staphylococcus aureus surgical site infection in the Swiss surveillance network: a cohort study.

Author information

1
Infection Control Programme, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.
2
Spine Centre Division, Department of Research and Development, Schulthess Klinik, Zurich, Switzerland.
3
SwissNoso, National Centre for Infection Prevention, Bern, Switzerland; Service of Infectious Diseases, Central Institute of the Valais Hospitals, Sion, Switzerland.
4
SwissNoso, National Centre for Infection Prevention, Bern, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Zurich, Zurich, Switzerland.
5
SwissNoso, National Centre for Infection Prevention, Bern, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
6
Infection Control Programme, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland; SwissNoso, National Centre for Infection Prevention, Bern, Switzerland. Electronic address: stephan.harbarth@hcuge.ch.
7
SwissNoso, National Centre for Infection Prevention, Bern, Switzerland.

Abstract

BACKGROUND:

Staphylococcus aureus is the leading pathogen in surgical site infections (SSI).

AIM:

To explore trends and risk factors associated with S. aureus SSI.

METHODS:

Risk factors for monomicrobial S. aureus SSI were identified from the Swiss multi-centre SSI surveillance system using multi-variate logistic regression. Both in-hospital and postdischarge SSI were identified using standardized definitions.

FINDINGS:

Over a six-year period, data were collected on 229,765 surgical patients, of whom 499 (0.22%) developed monomicrobial S. aureus SSI; 459 (92.0%) and 40 (8.0%) were due to meticillin-susceptible S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA), respectively. There was a significant decrease in the rate of MSSA SSI (P = 0.007), but not in the rate of MRSA SSI (P = 0.70). Independent protective factors for S. aureus SSI were older age [≥75 years vs <50 years: odds ratio (OR) 0.60, 95% confidence interval (CI) 0.44-0.83], laparoscopy/minimally invasive surgery (OR 0.68, 95% CI 0.50-0.92), non-clean surgery [OR 0.78 (per increase in wound contamination class), 95% CI 0.64-0.94] and correct timing of pre-operative antibiotic prophylaxis (OR 0.80, 95% CI 0.65-0.98). Independent risk factors were male sex (OR 1.38, 95% CI 1.14-1.66), higher American Society of Anesthesiologists' score (per one-point increment: OR 1.30, 95% CI 1.13-1.51), re-operation for non-infectious reasons (OR 4.59, 95% CI 3.59-5.87) and procedure type: cardiac surgery, laminectomy, and hip or knee arthroplasty had two-to nine-fold increased odds of S. aureus SSI compared with other procedures.

CONCLUSIONS:

SSI due to S. aureus are decreasing and becoming rare events in Switzerland. High-risk procedures that may benefit from specific preventive measures were identified. Unfortunately, many of the independent risk factors are not easily modifiable.

KEYWORDS:

Cohort study; Risk factors; Staphylococcus aureus; Surgical site infection; Surveillance of healthcare-associated infection

PMID:
28988937
DOI:
10.1016/j.jhin.2017.09.025
[Indexed for MEDLINE]

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