Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-17T18:47:35.946Z Has data issue: false hasContentIssue false
  • English
  • Français

Severe Surgical Site Infection in Community Hospitals: Epidemiology, Key Procedures, and the Changing Prevalence of Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Deverick J. Anderson ,
Daniel J. Sexton ,
Zeina A. Kanafani ,
Grace Auten  and
Keith S. Kaye
Deverick J. Anderson*
Affiliation:
Department of Medicine, Division of Infectious Diseases, and the Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Department of Medicine, Division of Infectious Diseases, and the Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Zeina A. Kanafani
Affiliation:
Department of Medicine, Division of Infectious Diseases, and the Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Grace Auten
Affiliation:
Department of Medicine, Division of Infectious Diseases, and the Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Keith S. Kaye
Affiliation:
Department of Medicine, Division of Infectious Diseases, and the Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
*
DUMC, Box 3605, Durham, NC, USA 27710 (deverick.anderson@duke.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To characterize the epidemiology of severe (ie, nonsuperficial) surgical site infection (SSI) in community hospitals.

Methods.

SSI data were collected prospectively at 26 community hospitals in the southeastern United States. Two analyses were performed: (1) a study of the overall prevalence rates of SSI and the prevalence rates of SSI due to specific pathogens in 2005 at all participating hospitals and (2) a prospective study of consecutive surgical procedures at 9 of the 26 community hospitals from 2000 through 2005.

Results.

In 2005, a total of 1,010 SSIs occurred after 89,302 procedures (prevalence rate, 1.13 infections per 100 procedures). Methicillin-resistant S. aureus (MRSA) was the pathogen most commonly recovered (from 175 SSIs). Trend data from 2000 through 2005 demonstrated that the prevalence rate of MRSA SSI almost doubled during this period, increasing from 0.12 infections per 100 procedures (95% confidence interval [CI], 0.12-0.13) to 0.23 infections per 100 procedures (95% CI, 0.22-0.24) (P<.0001). In adjusted analysis, MRSA SSI was significantly more prevalent at the end of the study period than at the beginning (prevalence rate ratio, 1.48 [95% CI, 1.36-1.61]; P<.0001).

Conclusions.

MRSA was the pathogen that most commonly caused SSI in our network of community hospitals during 2005. The prevalence of MRSA SSI has increased significantly over the past 6 years.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 9 , September 2007 , pp. 1047 - 1053
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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. Graves, EJ, National Center for Health Statistics. National Hospital Discharge Survey: annual summary, 1987. Series 13, no. 99. Hyattsville, MD: Department of Health and Human Services (DHHS); 1989. DHHS publication (PHS) 89-1760. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/series/sr13/100-1/100-1.htm.Google Scholar
2. Cruse, P. Wound infection surveillance. Rev Infect Dis 1981;3:734–737.Google Scholar
3. Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.Google Scholar
4. Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
5. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.CrossRefGoogle ScholarPubMed
6. Cruse, PJ, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:27–40.Google Scholar
7. Coello, R, Glenister, H, Fereres, J, et al. The cost of infection in surgical patients: a case-control study. J Hosp Infect 1993;25:239–250.Google Scholar
8. Boyce, JM, Potter-Bynoe, G, Dziobek, L. Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol 1990;11:89–93.Google Scholar
9. Vegas, AA, Jodra, VM, Garcia, ML. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 1993;9:504–510.Google Scholar
10. VandenBergh, MF, Kluytmans, JA, van Hout, BA, et al. Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery. Infect Control Hosp Epidemiol 1996;17:786–792.Google Scholar
11. Hollenbeak, CS, Murphy, DM, Koenig, S, Woodward, RS, Dunagan, WC, Fraser, VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 2000;118:397–402.CrossRefGoogle ScholarPubMed
12. Whitehouse, JD, Friedman, ND, Kirkland, KB, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183–189.CrossRefGoogle Scholar
13. Apisarnthanarak, A, Jones, M, Waterman, BM, Carroll, CM, Bernardi, R, Fraser, VJ. Risk factors for spinal surgical-site infections in a community hospital: a case-control study. Infect Control Hosp Epidemiol 2003;24:31–36.CrossRefGoogle Scholar
14. Wong, ES. Surgical Site Infections. 3rd ed. Baltimore: Lippincott, Williams, and Wilkins; 2004.Google Scholar
15. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996: a report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control 1996;24:380–388.Google Scholar
16. Chattopadhyay, R, Zaroukian, S, Potvin, E. Surgical site infection rates at the Pontiac Health Care Centre, a rural community hospital. Can J Rural Med 2006;11:41–48.Google Scholar
17. Collier, C, Miller, DP, Borst, M. Community hospital surgeon-specific infection rates. Infect Control 1987;8:249–254.Google Scholar
18. Sharma, M, Berriel-Cass, D, Baran, J Jr Sternal surgical-site infection following coronary artery bypass graft: prevalence, microbiology, and complications during a 42-month period. Infect Control Hosp Epidemiol 2004;25:468–471.CrossRefGoogle ScholarPubMed
19. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
20. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S–157S.Google Scholar
21. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.Google Scholar
22. Kaye, KS, Sloane, R, Sexton, DJ, Schmader, KA. Risk factors for surgical site infections in older people. J Am Geriatr Soc 2006;54:391–396.Google Scholar
23. Kaye, KS, Engemann, JJ, Fulmer, EM, Clark, CC, Noga, EM, Sexton, DJ. Favorable impact of an infection control network on nosocomial infection rates in community hospitals. Infect Control Hosp Epidemiol 2006;27:228–232.Google Scholar
24. Richards, C, Emori, TG, Edwards, J, Fridkin, S, Tolson, J, Gaynes, R. Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999. Am J Infect Control 2001;29:400–403.Google Scholar
25. National Center for Health Statistics (NCHS). Health, United States, 2006 (with chartbook on trends in the health of Americans). Hyattsville, MD; NCHS: 2006. Available at: http://www.cdc.gov/nchs/data/hus/hus06.pdf. Accessed July 6, 2007.Google Scholar
26. Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther 2001;43:92–97.Google Scholar
27. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. American Society of Health-System Pharmacists. Am J Health Syst Pharm 1999;56:1839–1888.CrossRefGoogle Scholar
28. Bratzler, DW, Houck, PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004;38:1706–1715.Google ScholarPubMed
29. Bratzler, DW, Hunt, DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006;43:322–330.Google Scholar
30. Bolon, MK, Morlote, M, Weber, SG, Koplan, B, Carmeli, Y, Wright, SB. Glycopeptides are no more effective than β-lactam agents for prevention of surgical site infection after cardiac surgery: a meta-analysis. Clin Infect Dis 2004;38:1357–6133.Google Scholar
31. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1995;44(RR-12):1–13.Google Scholar
32. Perl, TM, Cullen, JJ, Wenzel, RP, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002;346:1871–1877.Google Scholar
33. Segers, P, Speekenbrink, RG, Ubbink, DT, van Ogtrop, ML, de Mol, BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 2006;296:2460–2466.CrossRefGoogle ScholarPubMed
34. Loeb, M, Main, C, Walker-Dilks, C, Eady, A. Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database Syst Rev 2003:CD003340.Google Scholar
35. Wren, MW, Carder, C, Coen, PG, Gant, V, Wilson, AP. Rapid molecular detection of methicillin-resistant Staphylococcus aureus . J Clin Microbiol 2006;44:1604–1605.Google Scholar
36. Diep, BA, Gill, SR, Chang, RF, et al. Complete genome sequence of USA300, an epidemic clone of community-acquired methicillin-resistant Staphylococcus aureus . Lancet 2006;367:731–739.Google Scholar
37. Kazakova, SV, Hageman, JC, Matava, M, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005;352:468–475.CrossRefGoogle ScholarPubMed