High-risk Staphylococcus aureus transmission in the operating room: A call for widespread improvements in perioperative hand hygiene and patient decolonization practices - 27/09/18
, Franklin Dexter, MD, PhD, FASA, Alysha D.M. Robinson, BSHighlights |
• | Intraoperative Staphylococcus aureus multilocus sequence type 5 is hypertransmissible and pathogenic. |
• | Intraoperative provider hands and patient skin surfaces are confirmed sources of sequence type 5 transmission. |
Abstract |
Background |
Increased awareness of the epidemiology of transmission of pathogenic bacterial strain characteristics may help to improve compliance with intraoperative infection control measures. Our aim was to characterize the epidemiology of intraoperative transmission of high-risk Staphylococcus aureus sequence types (STs).
Methods |
S aureus isolates collected from 3 academic medical centers underwent whole cell genome analysis, analytical profile indexing, and biofilm absorbance. Transmission dynamics for hypertransmissible, strong biofilm-forming, antibiotic-resistant, and virulent STs were assessed.
Results |
S aureus ST 5 was associated with increased risk of transmission (adjusted incidence risk ratio, 6.67; 95% confidence interval [CI], 1.82-24.41; P = .0008), greater biofilm absorbance (ST 5 median absorbance ± SD, 3.08 ± 0.642 vs other ST median absorbance ± SD, 2.38 ± 1.01; corrected P = .021), multidrug resistance (odds ratio, 7.82; 95% CI, 2.19-27.95; P = .002), and infection (6/38 ST 5 vs 6/140 STs; relative risk, 3.68; 95% CI, 1.26-10.78; P = .022). Provider hands (n = 3) and patients (n = 4) were confirmed sources of ST 5 transmission. Transmission locations included provider hands (n = 3), patient skin sites (n = 4), and environmental surfaces (n = 2). All observed transmission stories involved the within-case mode of transmission. Two of the ST 5 transmission events were directly linked to infection.
Conclusions |
Intraoperative S aureus ST 5 isolates are hypertransmissible and pathogenic. Improved compliance with hand hygiene and patient decolonization may help to control the spread of these dangerous pathogens.
Le texte complet de cet article est disponible en PDF.Key Words : High-risk Staphylococcus aureus, intraoperative, operating room, transmission, multidrug resistance, postoperative infection
Plan
| Funding/support: Supported by the University of Iowa. |
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| Author contributions: R.W.L. helped design the study, conduct the study, analyze the data, and write the manuscript. F.D. helped analyze the data and write the manuscript. A.D.M.R. helped conduct the study. All authors approved the final version of the manuscript. |
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| Conflicts of interest: R.W.L. reported research funding from Sage Medical Inc., has one or more patents pending, and is a shareholder in RDB Bioinformatics, LLC, and 1055 N 115th St #301, Omaha, NE 68154. A.D.M.R. and F.D. have no conflicts of interest. |
Vol 46 - N° 10
P. 1134-1141 - octobre 2018 Retour au numéro
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