Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T17:18:40.489Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ([email protected])
Get access Rights & Permissions [Opens in a new window]

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

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.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
2.Anderson, DJ, Sexton, DJ, Kanafani, ZA, Auten, G, Kaye, KS. Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2007;28:1047–1053.Google Scholar
3.Jernigan, JA. Is the burden of Staphylococcus aureus among patients with surgical-site infections growing? Infect Control Hosp Epidemiol 2004;25:457–460.CrossRefGoogle ScholarPubMed
4.Ross, H. Postoperative wound infection with methicillin-resistant staphylococci in general surgical patients. Aust N Z J Surg 1985;55:13–17.CrossRefGoogle ScholarPubMed
5.Manian, FA, Meyer, PL, Setzer, J, Senkel, D. Surgical site infections associated with methicillin-resistant Staphylococcus aureus: do postoperative factors play a role? Clin Infect Dis 2003;36:863–868.Google Scholar
6.Dodds Ashley, ES, Carroll, DN, Engemann, JJ, et al.Risk factors for postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2004;38:1555–1560.Google Scholar
7.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
8.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.CrossRefGoogle ScholarPubMed
9.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.CrossRefGoogle ScholarPubMed
10.Mannien, J, van den Hof, S, Brandt, C, Behnke, M, Wille, JC, Gastmeier, P. Comparison of the National Surgical Site Infection surveillance data between The Netherlands and Germany: PREZIES versus KISS. J Hosp Infect 2007;66:224–231.Google Scholar
11.Yokoe, DS, Noskin, GA, Cunnigham, SM, et al.Enhanced identification of postoperative infections among inpatients. Emerg Infect Dis 2004;10:1924–1930.Google Scholar
12.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.CrossRefGoogle Scholar
13.Katz, S, Ford, AB, Moskowitz, RW, Jackson, BA, Jaffe, MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914–919.Google Scholar
14.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.Google Scholar
15.McCabe, WR, Jackson, GG. Gram-negative bacteremia. Arch Intern Med 1962;110:847–855.CrossRefGoogle Scholar
16.Landerman, R, Land, K, Pieper, C. An empirical evaluation of the predictive mean matching method for imputing missing values. Sociol Method Res 1997;26:3–33.Google Scholar
17.Anderson, DJ, Kaye, KS. Skin and soft tissue infections in older adults. Clin Geriatr Med 2007;23:595–613, vii.CrossRefGoogle ScholarPubMed
18.Pessaux, P, Msika, S, Atalla, D, Hay, JM, Flamant, Y. Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. Arch Surg 2003;138:314–324.CrossRefGoogle ScholarPubMed
19.Raymond, DP, Pelletier, SJ, Crabtree, TD, Schulman, AM, Pruett, TL, Sawyer, RG. Surgical infection and the aging population. Am Surg 2001;67:827–832.CrossRefGoogle ScholarPubMed
20.Mylotte, JM, Graham, R, Kahler, L, Young, L, Goodnough, S. Epidemiology of nosocomial infection and resistant organisms in patients admitted for the first time to an acute rehabilitation unit. Clin Infect Dis 2000;30:425–432.Google Scholar
21.Pittet, D, Harbarth, S, Ruef, C, et al.Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland. Infect Control Hosp Epidemiol 1999;20:37–42.CrossRefGoogle ScholarPubMed
22.Viallon, A, Marjollet, O, Berthelot, P, et al.Risk factors associated with methicillin-resistant Staphylococcus aureus infection in patients admitted to the ED. Am J Emerg Med 2007;25:880–886.Google Scholar
23.Dronge, AS, Perkal, MF, Kancir, S, Concato, J, Asian, M, Rosenthal, RA. Long-term glycemic control and postoperative infectious complications. Arch Surg 2006;141:375–380.Google Scholar
24.Lee, J, Singletary, R, Schmader, K, Anderson, DJ, Bolognesi, M, Kaye, KS. Surgical site infection in the elderly following orthopaedic surgery. Risk factors and outcomes. J Bone Joint Surg Am 2006;88:1705–1712.Google Scholar
25.Huang, SS, Piatt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.Google Scholar
26.Bradley, SF, Terpenning, MS, Ramsey, MA, et al.Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.CrossRefGoogle ScholarPubMed
27.Mody, L, Maheshwari, S, Galecki, A, Kauffman, CA, Bradley, SF. Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc 2007;55:1921–1926.Google Scholar
28.Eun, SH, Lee, YS, Cha, JO, et al.The point prevalence and associated factors of nasal methicillin-resistant Staphylococcus aureus colonisation in eight geriatric hospitals in Korea. Clin Microbiol Infect 2006;12:81–83.CrossRefGoogle ScholarPubMed
29.Tada, A, Watanabe, T, Yokoe, H, Hanada, N, Tanzawa, H. Oral bacteria influenced by the functional status of the elderly people and the type and quality of facilities for the bedridden. J Appl Microbiol 2002;93:487–491.CrossRefGoogle ScholarPubMed
30.Troillet, N, Carmeli, Y, Samore, MH, et al.Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19:181–185.CrossRefGoogle ScholarPubMed
31.von Baum, H, Schmidt, C, Svoboda, D, Bock-Hensley, O, Wendt, C. Risk factors for methicillin-resistant Staphylococcus aureus carriage in residents of German nursing homes. Infect Control Hosp Epidemiol 2002;23:511–515.Google Scholar
32.Bradley, SF. Methicillin-resistant Staphylococcus aureus: long-term care concerns. Am J Med 1999;106:2S–10S.CrossRefGoogle ScholarPubMed
33.Kluytmans, JA, Mouton, JW, Ijzerman, EP, et al.Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995;171:216–219.CrossRefGoogle Scholar
34.Nunley, D, Berk, SL. Percutaneous endoscopic gastrostomy as an unrecognized source of methicillin-resistant Staphylococcus aureus colonization. Am J Gastroenterol 1992;87:58–61.Google Scholar