University Hospital and University Jean Monnet, Saint Etienne, France.
Eur J Clin Microbiol Infect Dis. 2010 Apr;29(4):373-82. doi: 10.1007/s10096-009-0867-5. Epub 2010 Jan 28.
The endogenous or exogenous origin of Staphylococcus aureus, responsible for orthopaedic surgical-site infections (SSI), remains debated. We conducted a multicentre prospective cohort study to analyse the respective part of exogenous contamination and endogenous self-inoculation by S. aureus during elective orthopaedic surgery. The nose of each consecutive patient was sampled before surgery. Strains of S. aureus isolated from the nose and the wound, in the case of SSI, were compared by antibiotypes or pulsed-field gel electrophoresis (PFGE). A total of 3,908 consecutive patients undergoing orthopaedic surgery were included. Seventy-seven patients developed an SSI (2%), including 22 related to S. aureus (0.6%). S. aureus was isolated from the nose of 790 patients (20.2%) at the time of surgery. In the multivariate analysis, S. aureus nasal carriage was found to be a risk factor for S. aureus SSI in orthopaedic surgery. However, only nine subjects exhibiting S. aureus SSI had been found to be carriers before surgery: when compared, three pairs of strains were considered to be different and six similar. In most cases of S. aureus SSI, either an endogenous origin could not be demonstrated or pre-operative nasal colonisation retrieved a strain that was different from the one recovered from the surgical site.
金黄色葡萄球菌（Staphylococcus aureus）是引起骨科手术部位感染（SSI）的原因，其究竟是内源性还是外源性来源一直存在争议。我们开展了一项多中心前瞻性队列研究，旨在分析择期骨科手术中金黄色葡萄球菌的外源性污染和内源性自身接种的各自作用。在手术前，对每例连续患者的鼻子进行采样。对从鼻子和伤口（如果发生 SSI）分离出的金黄色葡萄球菌菌株，通过抗生素型或脉冲场凝胶电泳（PFGE）进行比较。共纳入 3908 例连续接受骨科手术的患者。77 例患者发生 SSI（2%），其中 22 例与金黄色葡萄球菌有关（0.6%）。手术时，790 例患者（20.2%）的鼻子中分离出金黄色葡萄球菌。多变量分析显示，金黄色葡萄球菌鼻腔携带是骨科手术中金黄色葡萄球菌 SSI 的危险因素。然而，仅有 9 例金黄色葡萄球菌 SSI 患者术前被发现携带金黄色葡萄球菌：经比较，3 对菌株被认为不同，6 对菌株相似。在大多数金黄色葡萄球菌 SSI 病例中，要么无法证明其为内源性起源，要么术前鼻腔定植可恢复与从手术部位分离出的菌株不同的菌株。
