Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina 27710, USA.
Infect Control Hosp Epidemiol. 2010 Jul;31(7):701-9. doi: 10.1086/653205.
To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.design. Retrospective cohort study.
Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia.
Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures.
We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson chi2 test, Student t test, or Wilcoxon rank-sum test, as appropriate.
In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43-0.52); 227 (51%) of 446 infections were due to methicillin-resistant S.aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95%CI, 0.62-0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32-0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53-0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17-0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43-0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95% CI, 0.42-0.59]; P < .001, compared with other procedure types), comprising 80% of invasive S.aureus infections after these procedures.
The frequency and type of postoperative invasive S. aureus infection varied significantly across procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for ongoing preventative interventions.
确定 4 种主要手术类型后术后侵袭性金黄色葡萄球菌感染的流行病学特征。
回顾性队列研究。
北卡罗来纳州和弗吉尼亚州的 11 家医院（9 家社区医院和 2 家三级保健医院）。
接受矫形、神经外科、心胸和整形手术的成年人。
我们使用了先前经过验证的、前瞻性收集的手术部位感染监测数据和血流感染的微生物学数据。研究期间为 2003 年至 2006 年。我们将侵袭性金黄色葡萄球菌感染定义为非浅表切口手术部位感染或血流感染。使用非参数引导法生成 95%置信区间（CI）。使用 Pearson chi2 检验、学生 t 检验或 Wilcoxon 秩和检验生成 P 值，具体取决于适用情况。
在研究期间，共有 81267 名患者接受了 96455 例手术。侵袭性金黄色葡萄球菌感染的总体发生率为每 100 例手术 0.47 例（95%CI，0.43-0.52）；446 例感染中，227 例（51%）是耐甲氧西林金黄色葡萄球菌引起的。心胸外科手术后侵袭性金黄色葡萄球菌感染更为常见（每 100 例手术发生率为 0.79 例[95%CI，0.62-0.97]），而矫形外科手术后（每 100 例手术发生率为 0.37 例[95%CI，0.32-0.42]）、神经外科手术后（每 100 例手术发生率为 0.62 例[95%CI，0.53-0.72]）或整形手术后（每 100 例手术发生率为 0.32 例[95%CI，0.17-0.47]）（P<.001）。同样，金黄色葡萄球菌血流感染在心胸外科手术后最为常见（每 100 例手术发生率为 0.57 例[95%CI，0.43-0.72]；P<.001，与其他手术类型相比），占这些手术后侵袭性金黄色葡萄球菌感染的近四分之三。神经外科手术后手术部位感染发生率最高（每 100 例手术发生率为 0.50 例[95%CI，0.42-0.59]；P<.001，与其他手术类型相比），占这些手术后侵袭性金黄色葡萄球菌感染的 80%。
术后侵袭性金黄色葡萄球菌感染的频率和类型在手术类型之间存在显著差异。高危手术，如心胸外科手术，应作为持续预防干预的目标。
