Infection Control Programme, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.
Spine Centre Division, Department of Research and Development, Schulthess Klinik, Zurich, Switzerland.
J Hosp Infect. 2018 Feb;98(2):118-126. doi: 10.1016/j.jhin.2017.09.025. Epub 2017 Oct 6.
Staphylococcus aureus is the leading pathogen in surgical site infections (SSI).
To explore trends and risk factors associated with S. aureus SSI.
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.
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.
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.
金黄色葡萄球菌是手术部位感染（SSI）的主要病原体。
探讨金黄色葡萄球菌 SSI 的趋势和相关危险因素。
使用多变量逻辑回归从瑞士多中心 SSI 监测系统中确定单微生物金黄色葡萄球菌 SSI 的危险因素。使用标准化定义确定住院期间和出院后 SSI。
在六年期间，共收集了 229765 例手术患者的数据，其中 499 例（0.22%）发生单微生物金黄色葡萄球菌 SSI；459 例（92.0%）和 40 例（8.0%）分别归因于耐甲氧西林金黄色葡萄球菌（MSSA）和耐甲氧西林金黄色葡萄球菌（MRSA）。MSSA SSI 的发生率显著下降（P=0.007），但 MRSA SSI 的发生率没有变化（P=0.70）。金黄色葡萄球菌 SSI 的独立保护因素为年龄较大（≥75 岁与<50 岁：比值比（OR）0.60，95%置信区间（CI）0.44-0.83）、腹腔镜/微创手术（OR 0.68，95%CI 0.50-0.92）、非清洁手术[OR 0.78（每增加伤口污染等级），95%CI 0.64-0.94]和术前抗生素预防的正确时机（OR 0.80，95%CI 0.65-0.98）。独立危险因素为男性（OR 1.38，95%CI 1.14-1.66）、美国麻醉师协会评分较高（每增加一分：OR 1.30，95%CI 1.13-1.51）、因非传染性原因再次手术（OR 4.59，95%CI 3.59-5.87）和手术类型：与其他手术相比，心脏手术、椎板切除术以及髋关节或膝关节置换术发生金黄色葡萄球菌 SSI 的几率增加了两到九倍。
金黄色葡萄球菌导致的 SSI 在瑞士呈下降趋势，且变得罕见。确定了可能受益于特定预防措施的高危手术。不幸的是，许多独立危险因素不容易改变。
