Association of Staphylococcus aureus Bacterial Load and Colonization Sites With the Risk of Postoperative S. aureus Infection
Author:
Troeman Darren P R1ORCID, Hazard Derek2, van Werkhoven Cornelis H W1, Timbermont Leen3, Malhotra-Kumar Surbhi3ORCID, Wolkewitz Martin2, Ruzin Alexey4, Sifakis Frangiscos5, Harbarth Stephan6, Kluytmans Jan A J W17, , Goossens Herman, Vlaeminck Jelle, Vilken Tuba, Xavier Basil Britto, Lammens Christine, Bonten Marc, van Esschoten Marjolein, Paling Fleur, Recanatini Claudia, Coenjaerts Frank, Selman Brett, Tkaczyk Christine, Weber Susanne, Ekkelenkamp Miquel, van der Laan Lijckle, Vierhout Bas, Couvé-Deacon Elodie, David Miruna, Chadwick David, Llewelyn Martin, Ustianowski Andrew, Bateman Tony, Mawer Damian, Carevic Biljana, Konstantinovic Sonja, Djordjevic Zorana, del Toro López María Dolores, Horcajada Juan P, Escudero Dolores, Rojo Miquel Pujol, de la Torre Cisneros Julián, Castelli Francesco, Nardi Giuseppe, Barbadoro Pamela, Altmets Mait, Mitt Piret, Todor Adrian, Turconi Serban Ion Bubenek, Corneci Dan, Săndesc Dorel, Gheorghita Valeriu, Brat Radim, Hanke Ivo, Neumann Jan, Tomáš Tomáš, Laffut Wim, Van den Abeele Annemie, Van Rooij Sanne, Schasfoort Edith, Brugman Curt, Couperus Janet, Van Beek Karin, Cuperus Nienke, Corthals Sophie, Bryssinck Liesbeth, Solomon Stalin, Chapelle Sabine, Vanderstraeten Anouk
Affiliation:
1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands 2. Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg , Freiburg , Germany 3. Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp , Antwerp , Belgium 4. Microbial Sciences, R&D BioPharmaceuticals, AstraZeneca , Gaithersburg, Maryland , USA 5. Gilead Sciences, Inc , Foster City, California , USA 6. Infection Control Programme and WHO Collaborating Center, Geneva University Hospitals and Faculty of Medicine , Geneva , Switzerland 7. Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands
Abstract
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 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.
Results
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).
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.
Funder
Innovative Medicines Initiative European Union Seventh Framework Programme European Federation of Pharmaceutical Industries and Associations
Publisher
Oxford University Press (OUP)
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