Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
JAMA Netw Open. 2023 Oct 2;6(10):e2339793. doi: 10.1001/jamanetworkopen.2023.39793.
Staphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies.
To assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study assessed surgical patients at 33 hospitals in 10 European countries who were recruited between December 16, 2016, and September 30, 2019 (follow-up through December 30, 2019). Enrolled patients were actively followed up for up to 90 days after surgery to assess the occurrence of S aureus SSIs and BSIs. Data analysis was performed between November 20, 2020, and April 21, 2022. All patients were 18 years or older and had undergone 11 different types of surgical procedures. They were screened for S aureus colonization in the nose, throat, and perineum within 30 days before surgery (source population). Both S aureus carriers and noncarriers were subsequently enrolled in a 2:1 ratio.
Preoperative S aureus colonization.
The main outcome was cumulative incidence of S aureus SSIs and BSIs estimated for the source population, using weighted incidence calculation. The independent association of candidate variables was estimated using multivariable Cox proportional hazards regression models.
In total, 5004 patients (median [IQR] age, 66 [56-72] years; 2510 [50.2%] female) were enrolled in the study cohort; 3369 (67.3%) were S aureus carriers. One hundred patients developed S aureus SSIs or BSIs within 90 days after surgery. The weighted cumulative incidence of S aureus SSIs or BSIs was 2.55% (95% CI, 2.05%-3.12%) for carriers and 0.52% (95% CI, 0.22%-0.91%) for noncarriers. Preoperative S aureus colonization (adjusted hazard ratio [AHR], 4.38; 95% CI, 2.19-8.76), having nonremovable implants (AHR, 2.00; 95% CI, 1.15-3.49), undergoing mastectomy (AHR, 5.13; 95% CI, 1.87-14.08) or neurosurgery (AHR, 2.47; 95% CI, 1.09-5.61) (compared with orthopedic surgery), and body mass index (AHR, 1.05; 95% CI, 1.01-1.08 per unit increase) were independently associated with S aureus SSIs and BSIs.
In this cohort study of surgical patients, S aureus carriage was associated with an increased risk of developing S aureus SSIs and BSIs. Both modifiable and nonmodifiable etiologic factors were associated with this risk and should be addressed in those at increased S aureus SSI and BSI risk.
重要性：金黄色葡萄球菌手术部位感染（SSI）和血流感染（BSI）是手术的重要并发症，预防效果仍不理想。需要了解这些感染的发生率和病因因素，以支持开发改进的预防策略。
目的：评估手术后金黄色葡萄球菌 SSI 和 BSI 的发生情况，并定量评估其与患者相关和背景因素的关系。
设计、地点和参与者：这项多中心队列研究评估了 10 个欧洲国家 33 家医院的手术患者，这些患者于 2016 年 12 月 16 日至 2019 年 9 月 30 日（随访至 2019 年 12 月 30 日）期间被招募。对术后 90 天内发生的金黄色葡萄球菌 SSI 和 BSI 进行了积极的随访。数据分析于 2020 年 11 月 20 日至 2022 年 4 月 21 日进行。所有患者年龄均为 18 岁或以上，并接受了 11 种不同类型的手术。在手术前 30 天内对其鼻腔、喉咙和会阴部位的金黄色葡萄球菌定植情况进行了筛查（源人群）。对金黄色葡萄球菌携带者和非携带者进行了 2:1 的比例招募。
暴露：术前金黄色葡萄球菌定植。
主要结局和测量指标：主要结局是使用加权发生率计算估计源人群中金黄色葡萄球菌 SSI 和 BSI 的累积发生率。使用多变量 Cox 比例风险回归模型评估候选变量的独立关联。
结果：共纳入 5004 例患者（中位数[IQR]年龄，66[56-72]岁；2510[50.2%]为女性）进入研究队列；3369 例（67.3%）为金黄色葡萄球菌携带者。100 例患者在手术后 90 天内发生金黄色葡萄球菌 SSI 或 BSI。金黄色葡萄球菌携带者的 SSI 或 BSI 的加权累积发生率为 2.55%（95%CI，2.05%-3.12%），而非携带者的发生率为 0.52%（95%CI，0.22%-0.91%）。术前金黄色葡萄球菌定植（调整后的危险比[AHR]，4.38；95%CI，2.19-8.76）、有不可移除的植入物（AHR，2.00；95%CI，1.15-3.49）、接受乳房切除术（AHR，5.13；95%CI，1.87-14.08）或神经外科手术（AHR，2.47；95%CI，1.09-5.61）（与骨科手术相比）和体重指数（AHR，1.05；95%CI，1.01-1.08，每单位增加）与金黄色葡萄球菌 SSI 和 BSI 独立相关。
结论和相关性：在这项针对手术患者的队列研究中，金黄色葡萄球菌定植与金黄色葡萄球菌 SSI 和 BSI 的发生风险增加相关。可改变和不可改变的病因因素均与该风险相关，应在金黄色葡萄球菌 SSI 和 BSI 风险增加的患者中予以解决。
