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An Outbreak of Coagulase-Negative Staphylococcal Surgical-Site Infections Following Aortic Valve Replacement

Published online by Cambridge University Press:  02 January 2015

Rebecca L. Lark ,
Kristi VanderHyde ,
G. Michael Deeb ,
Steve Dietrich ,
Jeffrey P. Massey  and
Carol Chenoweth
Rebecca L. Lark
Affiliation:
Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
Kristi VanderHyde
Affiliation:
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
G. Michael Deeb
Affiliation:
Michigan Department of Community Health Laboratories, Division of Infectious Diseases, Lansing, Michigan
Steve Dietrich
Affiliation:
Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Jeffrey P. Massey
Affiliation:
Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Carol Chenoweth*
Affiliation:
Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
*
Division of Infectious Diseases, University of Michigan Health System, 1500 E Medical Center Dr, Room 3116 TC, Ann Arbor, MI 48109-4378
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Abstract

Objectives:

To determine the cause of a coagulase-negative staphylococcal outbreak and to identify risk factors for surgical-site infections among patients following Medtronic Freestyle bioprosthesis implantation.

Design:

Retrospective case-control study.

Setting:

An 800-bed university referral center.

Patients:

The cohort of 64 patients undergoing Freestyle valve replacement from September 1998 to December 1998.

Results:

Seven patients developed infection (10.9% vs 1.1% during the preceding 8 months), including two with mediastinals and five with endocarditis. There were no statistically significant differences between cases and controls with respect to age, gender, weight, underlying illness, preoperative hospital stay, duration of surgery, time on bypass, central venous catheter duration, National Nosocomial Infection Surveillance risk index, New York Heart Association class, albumin, or antibiotic prophylaxis. However, only three cases were documented to have received vancomycin prophylaxis. Of all staff evaluated, only surgical resident A was significantly associated with infection (odds ratio, 7.68; 95% confidence interval, 1.3-44.1; P=.02) Pulsed-field gel electrophoresis patterns on Staphylococcus epidermidis isolates from four of the six cases were identical. These cases were performed on different days. Surgical resident A was the only staff member present in the operating room for all cases caused by the epidemic strain. This S epidermidis strain, however, was not isolated from operating room staff.

Conclusion:

A surgical resident was significantly associated with infection. However, the cause of this outbreak was likely multifactorial. Changes occurring during the investigation included institution of vancomycin as routine prophylaxis and modification of surgical technique, which contributed to the resolution of the outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 10 , October 2001 , pp. 618 - 623
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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References

1. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Inject Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
2. 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
3. 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. Am J Med 1991;91(suppl 3B):152S–157S.CrossRefGoogle ScholarPubMed
4. Hedderwick, SA, McNeil, SA, Lyons, MJ, Kauffman, CA. Pathogenic organisms associated with artificial fingernails worn by healthcare workers. Infect Control Hosp Epidemiol 2000;21:505–509.CrossRefGoogle ScholarPubMed
5. Smith, C, Kleo, S, Cantor, C. Pulsed field gel electrophoresis and the technology of large DNA molecules. In: Davies, K, ed. Genome Analysis: A Practical Approach. Oxford, UK: IRL Press; 1988.Google Scholar
6. Tenover, F, Arbeit, R, Goering, R, Mickelsen, PA, Murray, BE, Persing, DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
7. Westaby, S, Jin, XY, Katsumata, T, Arifi, A, Braidley, P. Valve replacement with a stentless bioprosthesis: versatility of the porcine aortic root. J Thorac Cardiovasc Surg 1998;116:477–484.CrossRefGoogle ScholarPubMed
8. Sintek, CF, Fletcher, AD, Khonsari, S. Stentless porcine aortic root valve of choice for the elderly patient with small aortic root? J Thorac Cardiovasc Surg 1995;109:871–876.CrossRefGoogle ScholarPubMed
9. Doty, DB, Cafferty, A, Kon, ND, Huysmans, HA, Krause, AH, Westaby, S. Medtronic Freestyle aortic root bioprosthesis: implant techniques. J Card Surg 1998;13:369–375.CrossRefGoogle ScholarPubMed
10. Del Rizzo, DF, Fremes, SE, Goldman, BS, Christakis, GT, Sever, J, Musiani, A. Valvular surgery in the elderly. Cardiology in the Elderly 1995;3:199–206.Google Scholar
11. Weinstein, L, Brusch, J. Infective Endocarditis. New York, NY: Oxford University Press; 1996:210–228.Google Scholar
12. Mossad, SB, Serkey, JM, Longworth, DL, Cosgrove, DM III, Gordon, SM. Coagulase-negative staphylococcal sternal wound infections after open heart operations. Ann Thorac Surg 1997;63:395–401.CrossRefGoogle ScholarPubMed
13. Whitener, C, Caputo, GM, Weitekamp, MR, Karchmer, AW. Endocarditis due to coagulase-negative staphylococci: microbiologic, epidemiologic, and clinical considerations. Infect Dis Clin North Am 1993;7:81–96.CrossRefGoogle ScholarPubMed
14. Noble, W, Somerville, DA. Microbiology of the human skin. In: Rook, A, ed. Major Problems in Dermatology. London, UK: WB Saunders Co; 1974:121–143.Google Scholar
15. Kluytmans, J. 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
16. Huge, RM, Calia, FM, McLaughlin, JS, Hornick, RB. Sources of contamination in open heart surgery. JAMA 1974;230:1415–1418.Google Scholar
17. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR, Committee THICPA. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:247–278.CrossRefGoogle ScholarPubMed
18. Schaffner, W, Lefkowitz, L, Goodman, J. Hospital outbreak of infections with group A streptococci traced to an asymptomatic anal carrier. N Engl J Med 1969;280:1224–1225.CrossRefGoogle Scholar
19. Stamm, W, Feeley, J, Facklam, R. Wound infections due to group A streptococcus traced to a vaginal carrier. J Infect Dis 1978;138:287–292.CrossRefGoogle ScholarPubMed
20. Paul, S, Genese, C, Spitalny, K. Postoperative group A B-hemolytic streptococcus outbreak with the pathogen traced to a member of a healthcare worker's household. Infect Control Hosp Epidemiol 1990;11:643–646.CrossRefGoogle Scholar
21. Boyce, JM, Potter-Bynoe, G, Opal, SM, Dziobek, L, Medeiros, AA. A common-source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery. J Infect Dis 1990;161:493–499.CrossRefGoogle ScholarPubMed
22. Broek, PJ, Lampe, AS, Berbee, GAM, Thompson, J, Mouton, RP. Epidemic of prosthetic valve endocarditis caused by Staphylococcus epidermidis . BMJ 1985;291:949–950.CrossRefGoogle ScholarPubMed
23. Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281–286.CrossRefGoogle ScholarPubMed