Premier Applied Sciences, Premier, Inc, Charlotte, North Carolina, USA.
Health Economics and Outcomes Research, Pfizer, Inc, Collegeville, Pennsylvania, USA.
Clin Infect Dis. 2021 Nov 2;73(9):e2635-e2646. doi: 10.1093/cid/ciaa913.
Although Staphylococcus aureus is a leading cause of postsurgical infections, national estimates of these infections after elective surgeries based on microbiology data are limited. This study assessed cumulative 180-day postsurgical S. aureus incidence in real-world hospital settings.
A retrospective study of adults (≥18 years) undergoing inpatient or hospital-based outpatient elective surgeries from 1/7/2010-30/6/2015 at hospitals (N = 181) reporting microbiology results in the Premier Healthcare Database (PHD). 86 surgical categories were identified from the National Healthcare Safety Network procedures. We classified positive S. aureus cultures using a hierarchy (bloodstream [BSI], surgical site [SSI], and all other types [urinary tract, respiratory, other/unknown site]) and calculated incidence (number of infections divided by the number of elective surgery discharges). We estimated national infection case volumes by multiplying incidence by national inpatient elective surgical discharge estimates using the entire PHD and weights based on hospital characteristics.
Following 884 803 inpatient elective surgical discharges, 180-day S. aureus infection incidence was 1.35% (0.30% BSI, 0.74% SSI no BSI, 0.32% all other types only). Among 1 116 994 hospital-based outpatient elective surgical discharges, 180-day S. aureus incidence was 1.19% (0.25% BSI, 0.75% SSI no BSI, 0.19% all other types only). Methicillin resistance was observed in ~45% of the S. aureus infections. We estimated 55 764 S. aureus postsurgical infections occurred annually in the US following 4.2 million elective inpatient surgical discharges.
The high burden of S. aureus infections after both inpatient and outpatient elective surgeries highlights the continued need for surveillance and novel infection prevention efforts.
金黄色葡萄球菌是术后感染的主要原因，但基于微生物数据的择期手术后感染的全国估计数据有限。本研究评估了真实医院环境中术后 180 天内金黄色葡萄球菌的累积发病率。
对 2010 年 1 月 7 日至 2015 年 6 月 30 日期间在 Premier Healthcare Database（PHD）报告微生物学结果的医院（N=181）接受住院或医院门诊择期手术的成年人（≥18 岁）进行回顾性研究。从全国医院感染监测系统（National Healthcare Safety Network）的手术程序中确定了 86 个手术类别。我们使用一个层次结构（血流感染[BSI]、手术部位感染[SSI]和所有其他类型[尿路感染、呼吸道感染、其他/未知部位]）对阳性金黄色葡萄球菌培养物进行分类，并计算发病率（感染数量除以择期手术出院数量）。我们通过将发病率乘以全国住院择期手术出院估计数，使用整个 PHD 和基于医院特征的权重来估计全国感染病例数。
在 884803 例住院择期手术出院后，180 天金黄色葡萄球菌感染发病率为 1.35%（0.30%BSI，0.74%SSI 无 BSI，0.32%其他类型仅）。在 1116994 例门诊择期手术出院中，180 天金黄色葡萄球菌感染发病率为 1.19%（0.25%BSI，0.75%SSI 无 BSI，0.19%其他类型仅）。金黄色葡萄球菌感染中约有 45%为耐甲氧西林。我们估计，在美国，每年有 55764 例金黄色葡萄球菌术后感染发生在 420 万例住院择期手术出院后。
住院和门诊择期手术后金黄色葡萄球菌感染的高负担突出表明需要持续进行监测和采取新的感染预防措施。
