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Poor Functional Status as a Risk Factor for Surgical Site Infection Due to Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Deverick J. Anderson ,
Luke F. Chen ,
Kenneth E. Schmader ,
Daniel J. Sexton ,
Yong Choi ,
Katherine Link ,
Rick Sloane  and
Keith S. Kaye
Deverick J. Anderson*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Duke Infection Control Outreach Network, and the Department of Medicine–Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
Luke F. Chen
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Duke Infection Control Outreach Network, and the Department of Medicine–Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
Kenneth E. Schmader
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Duke Infection Control Outreach Network, and the Department of Medicine–Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Duke Infection Control Outreach Network, and the Department of Medicine–Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
Yong Choi
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Duke Infection Control Outreach Network, and the Department of Medicine–Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
Katherine Link
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Duke Infection Control Outreach Network, and the Department of Medicine–Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
Rick Sloane
Affiliation:
Center for the Study of Aging and Human Development, Duke University Medical Center, Duke Infection Control Outreach Network, and the Department of Medicine–Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
Keith S. Kaye
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Duke Infection Control Outreach Network, and the Department of Medicine–Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
*
Duke University Medical Center, DUMC Box 3605, Durham, NC 27710 (dja@duke.edu)
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Abstract

Objective.

To identify risk factors for surgical site infection (SSI) due to methicillin-resistant Staphylococcus aureus (MRSA).

Design.

Prospective case-control study.

Setting.

One tertiary and 6 community-based institutions in the southeastern United States.

Methods.

We compared patients with SSI due to MRSA with 2 control groups: matched uninfected surgical patients and patients with SSI due to methicillin-susceptible S. aureus (MSSA). Multivariable logistic regression was used to determine variables independently associated with SSI due to MRSA, compared with each control group.

Results.

During the 5-year study period, 150 case patients with SSI due to MRSA were identified and compared with 231 matched uninfected control patients and 128 control patients with SSI due to MSSA. Two variables were independendy associated with SSI due to MRSA in both multivariable regression models: need for assistance with 3 or more activities of daily living (odds ratio [OR] compared with uninfected patients, 3.97 [95% confidence interval {CI}, 2.18-7.25]; OR compared with patients with SSI due to MSSA, 3.88 [95% CI, 1.91-7.87]) and prolonged duration of surgery (OR compared with uninfected patients, 1.98 [95% CI, 1.11-3.55]; OR compared with patients with SSI due to MSSA, 2.33 [95% CI, 1.17-4.62]). Lack of independence (ie, poor functional status) remained associated with an increased risk of SSI due to MRSA after stratifying by age.

Conclusions.

Poor functional status was highly associated with SSI due to MRSA in adult surgical patients, regardless of age. A patient's level of independence can be easily determined, and this information can be used preoperatively to target preventive interventions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 9 , September 2008 , pp. 832 - 839
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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