Abstract
Background
The independent effects of extranasal only carriage, carriage at multiple bodily sites, or the bacterial load of colonizing Staphylococcus aureus (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.
Methods
Surgical patients aged 18 years or older were screened for SA carriage in the nose, throat or perineum within 30 days prior to surgery. SA carriers and non-carriers 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.
Results
We enrolled 5,004 patients in the study cohort; 3,369 (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 to 8.5) and an increasing SA bacterial load in the nose (aHR 1.8 to 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).
Conclusions
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.
The independent effects of extranasal only carriage, carriage at multiple bodily sites, or the bacterial load of colonizing Staphylococcus aureus (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.
Methods
Surgical patients aged 18 years or older were screened for SA carriage in the nose, throat or perineum within 30 days prior to surgery. SA carriers and non-carriers 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.
Results
We enrolled 5,004 patients in the study cohort; 3,369 (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 to 8.5) and an increasing SA bacterial load in the nose (aHR 1.8 to 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).
Conclusions
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.
| Original language | English |
|---|---|
| Article number | ofae414 |
| Number of pages | 8 |
| Journal | Open Forum Infectious Diseases |
| Volume | 11 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 2024 |
Bibliographical note
Funding Information:Financial support. This work was supported by the Innovative Health Initiative Joint Undertaking (formerly known as Innovative Medicines Initiative Joint Undertaking) under grant agreement number 115523, which was composed of financial contributions from the European Union Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Associations companies in-kind contribution.
Funding Information:
In addition, we would like to acknowledge Sanne Van Rooij, MSc; Edith Schasfoort, MSc; Curt Brugman, MSc; Janet Couperus, MSc; Karin Van Beek, BSc; Nienke Cuperus, MSc, PhD; Sophie Corthals MSc, PhD (University Medical Center of Utrecht); Liesbeth Bryssinck, BSc; Stalin Solomon, BSc; Sabine Chapelle, BSc; and Anouk Vanderstraeten, BSc (University of Antwerp), who assisted with the study as part of their daily work activities; they were not compensated for this work. We also thank the operational teams of the national coordinators of COMBACTE who helped with the submission of the study to the local IRBs/ECs, all local investigators, monitors, other staff, and participating patients.
Publisher Copyright:
© The Author(s) 2024.
Keywords
- Staphylococcus aureus
- colonization
- hospital-acquired infection
- healthcare-associated infection