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Preoperative Nasal Methicillin-Resistant Staphylococcus aureus Status, Surgical Prophylaxis, and Risk-Adjusted Postoperative Outcomes in Veterans

Published online by Cambridge University Press:  02 January 2015

Kalpana Gupta ,
Judith Strymish ,
Youmna Abi-Haidar ,
Sandra A. Williams  and
Kamal M. F. Itani
Kalpana Gupta*
Affiliation:
Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Judith Strymish
Affiliation:
Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Youmna Abi-Haidar
Affiliation:
Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Sandra A. Williams
Affiliation:
Center for Organization, Leadership, and Management Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
Kamal M. F. Itani
Affiliation:
Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
*
VA Boston HCS, 1400 VFW Parkway, 111 Med, West Roxbury, MA 02132 (kalpana.gupta@va.gov)
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Abstract

Objectives.

To determine whether preoperative nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage is a significant predictor of postoperative infections, after accounting for surgical infection risk and surgical prophylaxis.

Design.

Retrospective cohort study.

Patients.

Veterans Affairs (VA) Boston patients who had nasal MRSA polymerase chain reaction screening performed in the 31 days before clean or clean contaminated surgery in 2008–2009.

Methods.

Postoperative MRSA clinical cultures and infections, total surgical site infections (SSIs), and surgical prophylaxis data were abstracted from administrative databases. MRSA infections were confirmed via chart review. Multivariate analysis of risk factors for each outcome was conducted using Poisson regression. SSI risk index was calculated for a subset of 1,551 patients assessed by the VA National Surgical Quality Improvement Program.

Results.

Among 4,238 eligible patients, 279 (6.6%) were positive for preoperative nasal MRSA. Postoperative MRSA clinical cultures and infections, including MRSA SSIs, were each significantly increased in patients with preoperative nasal MRSA. After adjustment for surgery type, vancomycin prophylaxis, chlorhexidine/alcohol surgical skin preparation, and SSI risk index, preoperative nasal MRSA remained significantly associated with postoperative MRSA cultures (relative risk [RR], 8.81; 95% confidence interval [CI], 3.01–25.82) and infections (RR, 8.46; 95% CI, 1.70–42.04). Vancomycin prophylaxis was associated with an increased risk of total SSI in those negative for nasal MRSA (RR, 4.34; 95% CI, 2.19–8.57) but not in patients positive for nasal MRSA.

Conclusions.

In our population, preoperative nasal MRSA colonization was independently associated with MRSA clinical cultures and infections in the postoperative period. Vancomycin prophylaxis increased the risk of total SSI in nasal MRSA-negative patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 8 , August 2011 , pp. 791 - 796
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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