Troeman Darren P R, Hazard Derek, van Werkhoven Cornelis H W, Timbermont Leen, Malhotra-Kumar Surbhi, Wolkewitz Martin, Ruzin Alexey, Sifakis Frangiscos, Harbarth Stephan, Kluytmans Jan A J W
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.
Open Forum Infect Dis. 2024 Jul 23;11(8):ofae414. doi: 10.1093/ofid/ofae414. eCollection 2024 Aug.
The independent effects of extranasal-only carriage, carriage at multiple bodily sites, or the bacterial load of colonizing (SA) on the risk of developing SA surgical site infections and postoperative bloodstream infections (SA SSI/BSIs) are unclear. We aimed to quantify these effects in this large prospective cohort study.
Surgical patients aged 18 years or older were screened for SA carriage in the nose, throat, or perineum within 30 days before surgery. SA carriers and noncarriers were enrolled in a prospective cohort study in a 2:1 ratio. Weighted multivariable Cox proportional hazard models were used to assess the independent associations between different measures of SA carriage and occurrence of SA SSI/BSI within 90 days after surgery.
We enrolled 5004 patients in the study cohort; 3369 (67.3%) were SA carriers. 100 SA SSI/BSI events occurred during follow-up, and 86 (86%) of these events occurred in SA carriers. The number of colonized bodily sites (adjusted hazard ratio [aHR], 3.5-8.5) and an increasing SA bacterial load in the nose (aHR, 1.8-3.4) were associated with increased SA SSI/BSI risk. However, extranasal-only carriage was not independently associated with SA SSI/BSI (aHR, 1.5; 95% CI, 0.9-2.5).
Nasal SA carriage was associated with an increased risk of SA SSI/BSI and accounted for the majority of SA infections. Higher bacterial load, as well as SA colonization at multiple bodily sites, further increased this risk.
仅鼻外携带、多个身体部位携带或定植金黄色葡萄球菌（SA）的细菌载量对发生SA手术部位感染和术后血流感染（SA SSI/BSIs）风险的独立影响尚不清楚。我们旨在通过这项大型前瞻性队列研究对这些影响进行量化。
对18岁及以上的手术患者在术前30天内进行鼻腔、咽喉或会阴部SA携带情况筛查。SA携带者和非携带者按2:1的比例纳入前瞻性队列研究。采用加权多变量Cox比例风险模型评估不同SA携带指标与术后90天内SA SSI/BSI发生之间的独立关联。
我们在研究队列中纳入了5004例患者；3369例（67.3%）为SA携带者。随访期间发生了100例SA SSI/BSI事件，其中86例（86%）发生在SA携带者中。定植身体部位的数量（调整后风险比[aHR]，3.5 - 8.5）以及鼻腔内SA细菌载量的增加（aHR，1.8 - 3.4）与SA SSI/BSI风险增加相关。然而，仅鼻外携带与SA SSI/BSI无独立关联（aHR，1.5；95%CI，0.9 - 2.5）。
鼻腔SA携带与SA SSI/BSI风险增加相关，且占SA感染的大多数。更高的细菌载量以及SA在多个身体部位的定植进一步增加了这种风险。
