Related Experiment Videos
An outbreak of coagulase-negative staphylococcal surgical-site infections following aortic valve replacement
R L Lark1, K VanderHyde, G M Deeb
1Department of Internal Medicine, University of Michigan Health System, Ann Arbor 48109-0378, USA.
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 mediastinitis 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 Awas 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.
Insights
A surgical resident was linked to a coagulase-negative staphylococcal outbreak following bioprosthesis implantation. The outbreak was multifactorial, but vancomycin prophylaxis and surgical technique changes resolved it.
Area of Science:
- Infectious Diseases
- Surgical Site Infections
- Epidemiology
Background:
- Coagulase-negative staphylococcal infections pose a significant risk following cardiac bioprosthesis implantation.
- Identifying the source and risk factors for such outbreaks is crucial for patient safety and effective intervention.
Purpose of the Study:
- To investigate the cause of a coagulase-negative staphylococcal outbreak after Medtronic Freestyle bioprosthesis implantation.
- To identify specific risk factors contributing to surgical-site infections in this patient population.
Main Methods:
- A retrospective case-control study was conducted at a university referral center.
- The study analyzed a cohort of 64 patients who underwent Freestyle valve replacement.
- Statistical analysis compared cases with infections to controls without infections.
Main Results:
- Seven patients developed infections (10.9%), including mediastinitis and endocarditis.
- No significant differences were found in patient demographics or standard perioperative factors.
- A surgical resident was significantly associated with infection (OR, 7.68), and epidemic strains were linked to cases involving this resident.
Conclusions:
- A surgical resident was identified as a significant factor in the outbreak.
- The outbreak was likely multifactorial, involving the identified resident and potentially other unisolated sources.
- Implementing vancomycin prophylaxis and modifying surgical techniques led to the resolution of the outbreak.