Virginie Forget1, Jérôme Fauconnier2, Sandrine Boisset3, Patricia Pavese4, Céline Vermorel5, Jean-Luc Bosson5, Dominique Saragaglia6, Jérôme Tonetti7, Marie-Reine Mallaret8, Caroline Landelle9. 1. Infection Control Unit, Savoie Hospital, Chambéry, France. 2. Univ Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France; Medical Information, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France. 3. Bacteriology Laboratory, Grenoble Alpes University Hospital, Grenoble, France. 4. Infectious Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France. 5. Univ Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France. 6. Department of Osteoarthritis and Sport Surgery, South Teaching Hospital, Grenoble Alpes University Hospital, Grenoble, France. 7. Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, Grenoble, France. 8. Univ Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France; Infection Control Unit, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France. 9. Univ Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France; Infection Control Unit, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France. Electronic address: caroline.landelle@gmail.com.
Abstract
BACKGROUND: Surgical site infections (SSI) after orthopaedic surgery are responsible for reduced quality of life, increased length of hospital stay and costs. The most commonly identified organism is Staphylococcus aureus but risk factors for S. aureus SSI are not well-known. The aim of this study was to evaluate the incidence rate trend of S. aureus SSI over the years and risk factors of these infections in a French University Hospital. METHODS: SSI rates were expressed as cumulative incidence rates per year. A case-control study nested within a prospective cohort of patients undergoing orthopaedic or trauma surgery from January 1st, 2012 to April 30th, 2015 was performed. Cases were patients with S. aureus SSI; controls were patients without SSI. Risk factors of S. aureus SSI were identified by univariate and multivariable analysis. RESULTS: Of 7438 interventions, 50 (0.7%) S. aureus SSI were identified, without significant increase by years. A total of 46 S. aureus SSI was matched to 91 controls. Risk factors for S. aureus SSI were smoking (odds-ratio (OR) = 8.4, 95%CI 1.2-59.6) and National Nosocomial Infections Surveillance System score (NNISS) ≥1 (OR = 5.8, 95%CI 1.8-19.1). Having 1 or 2 preoperative antiseptic showers (OR = 0.3, 95%CI 0.1-0.7) was a protective factor. CONCLUSION: The rate of S. aureus SSI is not negligible after orthopaedic and trauma surgery. It seems imperative to strengthen smoking cessation recommendations, and to recall the importance of preoperative antiseptic showers. Systematic screening and decolonization for S. aureus carriage before orthopaedic and trauma surgery could be a means to prevent these infections.
BACKGROUND: Surgical site infections (SSI) after orthopaedic surgery are responsible for reduced quality of life, increased length of hospital stay and costs. The most commonly identified organism is Staphylococcus aureus but risk factors for S. aureus SSI are not well-known. The aim of this study was to evaluate the incidence rate trend of S. aureus SSI over the years and risk factors of these infections in a French University Hospital. METHODS: SSI rates were expressed as cumulative incidence rates per year. A case-control study nested within a prospective cohort of patients undergoing orthopaedic or trauma surgery from January 1st, 2012 to April 30th, 2015 was performed. Cases were patients with S. aureus SSI; controls were patients without SSI. Risk factors of S. aureus SSI were identified by univariate and multivariable analysis. RESULTS: Of 7438 interventions, 50 (0.7%) S. aureus SSI were identified, without significant increase by years. A total of 46 S. aureus SSI was matched to 91 controls. Risk factors for S. aureus SSI were smoking (odds-ratio (OR) = 8.4, 95%CI 1.2-59.6) and National Nosocomial Infections Surveillance System score (NNISS) ≥1 (OR = 5.8, 95%CI 1.8-19.1). Having 1 or 2 preoperative antiseptic showers (OR = 0.3, 95%CI 0.1-0.7) was a protective factor. CONCLUSION: The rate of S. aureus SSI is not negligible after orthopaedic and trauma surgery. It seems imperative to strengthen smoking cessation recommendations, and to recall the importance of preoperative antiseptic showers. Systematic screening and decolonization for S. aureus carriage before orthopaedic and trauma surgery could be a means to prevent these infections.