Risk of Post-Surgical Staph Infection May Depend on Procedure

Patients may be at greater risk of developing invasive Staphylococcus aureus infections, following cardiothoracic and neurosurgical procedures compared with orthopedic or plastic surgical procedures according to a study published in the July issue of Infection Control and Hospital Epidemiology. The study also found S. aureus to be more common in tertiary care and high volume hospitals. 

In examining two forms of S. aureus infections, researchers found that the cardiothoracic infections were driven by bloodstream infections (BSI) while the neurosurgical infections were driven by non-superficial incisional surgical site infections (SSI). 

“The data show us that when we’re looking at strategies for improving outcomes, it’s likely that one single approach isn’t going to work for every situation,” said Deverick Anderson, MD, MPH, lead author of the study and member of Society for Healthcare Epidemiology of America.  “Our study shows that prevention needs to be procedure specific.” 

Researchers from the Duke University Medical Center examined post-surgical outcomes of 96,455 procedures from 11 hospitals, including nine community hospitals and two tertiary-care hospitals. Included in the retrospective analysis were patients who had undergone orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures between 2003 and 2006. 

Of the 96,455 procedures examined in the study, researchers found an overall rate of S. aureus of 0.47 percent, or .47/100, half of which were due to MRSA. The breakdown of MRSA infections by procedure were:

-- 62% following cardiothorasic surgery

-- 52% following orthopedic procedures

-- 43% following neurosurgical procedures

-- 35% following plastic surgery. 

 Furthermore, according to Anderson, examining the care provided in the intensive care unit following these procedures is also important in understanding the source of the infection.

 “This study adds an important aspect to our understanding of healthcare-associated infections. Not only do we need to emphasize the basic prevention methods known to be effective in reducing HAIs, but Anderson’s work shows us that one size does not fit all when it comes to prevention. The risk factors vary for different procedures and interventions must be tailored accordingly,” said Neil Fishman, MD, president of the Society for Healthcare Epidemiology of America.