Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T06:01:28.130Z Has data issue: false hasContentIssue false
  • English
  • Français

Nasal Carriage of Staphylococcus aureus: Is a Major Risk Factor for Surgical-Site Infections in Orthopedic Surgery

Published online by Cambridge University Press:  02 January 2015

Mathijs D. Kalmeijer ,
Ella van Nieuwland-Bollen ,
Diane Bogaers-Hofman ,
Gerard A.J. de Baere  and
Jan A.J.W. Kluytmans
Mathijs D. Kalmeijer
Affiliation:
Department of Pharmacy, Ignatius Hospital, Breda, The Netherlands
Ella van Nieuwland-Bollen
Affiliation:
Department of Clinical Microbiology and Infection Prevention, Ignatius Hospital, Breda, The Netherlands
Diane Bogaers-Hofman
Affiliation:
Department of Clinical Microbiology and Infection Prevention, Ignatius Hospital, Breda, The Netherlands
Gerard A.J. de Baere
Affiliation:
Department of Orthopedic Surgery, Ignatius Hospital, Breda, The Netherlands
Jan A.J.W. Kluytmans*
Affiliation:
Department of Clinical Microbiology and Infection Prevention, Ignatius Hospital, Breda, The Netherlands
*
Department of Clinical Microbiology and Infection Prevention, Ignatius Hospital Breda, PO Box 90158, 4800 RK Breda, The Netherlands
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the relative importance of different risk factors for the development of surgical-site infections (SSIs) in orthopedic surgery with prosthetic implants.

Design:

In a cohort of 272 patients, the following possible risk factors were studied: age, gender, method of hair removal, duration of operation, surgeon, underlying illness, and nasal carriage of Staphylococcus aureus. Infections were recorded following the Centers for Disease Control criteria. The relation between risk factors and SSI was tested in univariate and multiple logistic regression analysis.

Setting:

Community hospital in Breda, The Netherlands.

Results:

18 (6.6%) of 272 patients experienced SSI: 11 superficial and 7 deep SSI. These infections led in three cases to removal of the prosthesis and caused 286 extra days in hospital. The main causative pathogen was S aureus. In multiple logistic regression analysis, the following factors were independent risk factors for the development of SSI: high-level nasal carriage of S aureus (P=.04), male gender (P=.005), and surgeon 1 (P=.006). The only independent risk factor for SSI with S aureus was high-level nasal carriage of S aureus (P=.002).

Conclusion:

High-level nasal carriage of S aureus was the most important and only significant independent risk factor for developing SSI with S aureus.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 5 , May 2000 , pp. 319 - 323
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Weigelt, JA Risk of wound infections in trauma patients. Am J Surg 1985;150:782–784.CrossRefGoogle ScholarPubMed
2. Kluytmans, JAJW. Surgical infections including burns. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 3rd ed. Baltimore, MD: Williams & Wilkins; 1997:841–865.Google Scholar
3. Cruse, PJE, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:27–40.CrossRefGoogle Scholar
4. Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooten, TM. Identifying patients at high risk of surgical wound infection: a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206–215.CrossRefGoogle ScholarPubMed
5. Olson, MM, Lee, JT Jr. Continuous 10-year wound infection surveillance. Results, advantages and unanswered questions. Arch Surg 1990; 125:794–803.CrossRefGoogle ScholarPubMed
6. Culver, DH, Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91(suppl 3B):152S–157S.CrossRefGoogle ScholarPubMed
7. Mintjes-de Groot, AJ, Van den Berg, JMJ, Veerman-Brenzikofer, MLV, De Boer, AS, Smook, AOA. Frequentie van postoperatieve wondinfecties in Nederland. Ned Tijdschr Geneeskd 1998;142:22–26.Google Scholar
8. Green, JW, Wenzel, RP. Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg 1977;185:264–268.CrossRefGoogle ScholarPubMed
9. Coello, R, Glenister, H, Fereres, J, Bartlett, C, Leigh, D, Sedgwick, J, et al. The cost of infection in surgical patients: a case-control study. J Hosp Infect 1993;25:239–250.Google Scholar
10. Kluytmans, JA, Mouton, JW, Ijzerman, EP, Vandenbroucke-Grauls, CM, Maat, AW, Wagenvoort, JH, et al. Nasal carriage of S aureus as a major risk factor for wound infection after cardiac surgery. J Infect Dis 1995;171:216–219.Google Scholar
11. Ehrenkranz, NJ, Meakins, JL. Surgical infections. In: Bennet, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little Brown and Co; 1992:685–710.Google Scholar
12. Kluytmans, JAJW, Mouton, JW, Maat, APWM, Manders, MAAJ, Michel, MF, Wagenvoort, JHT Surveillance of postoperative infections in thoracic surgery. J Hosp Infect 1994;27:139–147.CrossRefGoogle ScholarPubMed
13. Petty, W. Infections of skeletal prostheses. In: Bennet, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little Brown and Co; 1992:749–766.Google Scholar
14. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
15. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992;20:271–274.CrossRefGoogle ScholarPubMed
16. Colbeck, JC, Robertson, HR, Sutherland, WH, Hartley, FC. The importance of endogenous staphylococcal infections in surgical patients. Canad Sen Med J 1959;15:326–331.Google ScholarPubMed
17. Weinstein, HJ. The relation between nasal-staphylococcal-carrier state and the incidence of postoperative complications. N Engl J Med 1959;260:1303–1308.CrossRefGoogle ScholarPubMed
18. Williams, REO, Patricia-Jevons, M, Shooter, RA, et al. Nasal staphylococci and sepsis in hospital patients. BMJ 1959;2:658–662.CrossRefGoogle ScholarPubMed
19. Kluytmans, JAJW, van Belkum, A, Verburgh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505–520.CrossRefGoogle ScholarPubMed
20. Calia, FM, Wolinsky, E, Mortimer, EA, Abram, JS, Rammelkamp, CH. Importance of the carrier state as a source of S aureus in wound sepsis. JHyg Camb 1969;67:49–57.Google Scholar
21. White, A. Increased infection rates in heavy nasal carriers of coagulase-positive staphylococci. Antimicrob Agents Chemother 1963;30:667–670.Google Scholar
22. Bruun, JN. Postoperative wound infection. Predisposing factors and the effect of a reduction in the dissemination of staphylococci. Acta Med Scand 1970;514(suppl):1–89.Google ScholarPubMed
23. Kluytmans, JAJW, Mouton, JW, Ijzerman, EPF, Vandenbroucke-Grauls, CMJE, Maat, AWPM, Wagenvoort, JHT, et al. Nasal carriage of S aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995;171:216–219.CrossRefGoogle Scholar
24. Kluytmans, J, Van Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505–520.CrossRefGoogle ScholarPubMed
25. Condon, RE, Schulte, WJ, Malangoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg 1983;118:303–307.Google Scholar
26. Olson, M, O'Conner, M, Schwartz, ML. Surgical wound infections. A 5-year prospective study of 20,193 wounds at the Minneapolis VA medical center. Ann Surg 1984;199:253–259.CrossRefGoogle Scholar
27. Mead, PB, Portes, SE, Hall, P, Vacek, PM, Davies, JH Jr, Gameiii, RL. Decreasing the incidence of surgical wound infections. Validation of a surveillance notification program. Arch Surg 1986;121:458–461.Google Scholar
28. Britt, MR, Schieuper, CJ, Matsumiya, S. Severity of underlying disease as a predictor of nosocomial infection: utility in the control of nosocomial infection. JAMA 1978;239:1047–1051.CrossRefGoogle ScholarPubMed
29. Hooton, TM, Haley, RW, Culver, DH, White, JW, Morgan, WM, Carroll, RJ. The joint association of multiple risk factors with the occurrence of nosocomial infection. Am J Med 1981;70:960–970.Google Scholar
30. Kluytmans, JA, Mouton, JW, VandenBerg, MF, Manders, MJ, Maat, AP, Wagenvoort, JH, et al. Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of S aureus . Infect Control Hosp Epidemiol 1996;17:780–785.CrossRefGoogle Scholar
31. VandenBergh, MF, Kluytmans, JA, van Hout, BA, Maat, AP, Seerden, RJ, McDonnel, J, et al. Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery. Infect Control Hosp Epidemiol 1996;17:786–792.Google Scholar