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  • Staphylococcus Aureus Colonization Among Neurosurgical Patients

    Final Number:
    1174

    Authors:
    Alexander J. Jonokuchi BS; Moises A. Martinez BS; Ryan E. Radwanski; Blake Eaton Samuel Taylor BA; Sean Sullivan MS; Eric Lo BS; Eliza M. Bruce BA; Sabrina Khan; Christopher P. Kellner MD; Brett Youngerman MD; Michael Rothbaum BA; Dimitri Sigounas MD; Jared Knopman MD; Peter D. Angevine MD; Franklin D. Lowy MD; E. Sander Connolly MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Staphylococcus aureus (SA) is the most common organism responsible for surgical-site infections (SSIs) in neurosurgical operations. SSIs impart substantial morbidity and mortality and have become a national focus of quality improvement. Patients colonized with SA preoperatively are at an increased risk of postoperative SA infections. However, the prevalence of SA colonization in the neurosurgical population is not well characterized.

    Methods: Patients were enrolled from our ongoing randomized controlled trial, “Topical Vancomycin for Neurosurgery Wound Prophylaxis” (NCT02284126), which will determine whether topical vancomycin applied at wound closure reduces the incidence of SSIs at postoperative day (POD) 30. Swabs of the nares and surgical site were obtained preoperatively before draping and at POD 14-30. Samples were screened for SA using standard microbiological procedures. Instrumented spine procedures were excluded due to a lack of clinical equipoise in this patient population.

    Results: Of the 128 patients enrolled in the trial as of 2/4/2015, 22 (17.2%) were colonized with SA in either the nares or at the surgical site. The vast majority (77.8%) remained colonized by POD 30. Two subjects, one treatment and one control, were newly colonized in the nares by POD 30. The control patient was also colonized at the incision site while the treatment patient was not. No SA isolates were methicillin-resistant. In univariate analysis, preoperative colonization was associated with postoperative colonization (P<0.001). Colonization was not significantly associated with application of topical vancomycin, ethnicity, BMI, inpatient status, or length of stay.

    Conclusions: These preliminary data report the prevalence of SA colonization and antibiotic resistance in the neurosurgical population. Our results suggest that SA colonization among this subgroup of neurosurgical patients at academic centers is low, however patients are likely to remain colonized (and thus at risk of infection) postoperatively. As enrollment continues, we will better characterize risk factors for SA colonization, SSIs, and potentially improve perioperative antibiotic management.

    Patient Care: We provide data on S. aureus prevalence in a neurosurgical population, showing that preoperatively colonized patients are likely to remain colonized after discharge. In addition, we found that several patients who were SA-negative preoperatively were colonized at follow-up, suggesting that new colonization, which would confer an increased risk of surgical-site infection, may be related to hospitalization or to the procedure performed. More generally, our ongoing trial will improve patient care by determining whether topical vancomycin reduces the incidence of surgical-site infections in neurosurgery.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of identifying patients at risk for surgical-site infections after neurosurgical procedures 2) Discuss, in small groups, the hospital and patient-specific factors that may influence the risk of S. aureus colonization, in particular “new” colonization 3) Identify an effective means of identifying S. aureus-colonized patients in order to better define prevalence at other centers

    References: 1. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: Incidence and impact on hospital utilization and treatment costs. American journal of infection control. 2009;37:387-97. doi: 10.1016/j.ajic.2008.12.010. PubMed PMID: 19398246. 2. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. The New England journal of medicine. 1996;334(19):1209-15. doi: 10.1056/NEJM199605093341901. PubMed PMID: 8606715. 3. Yasunaga H, Ide H, Imamura T, Ohe K. Accuracy of economic studies on surgical site infection. The Journal of hospital infection. 2007;65(2):102-7. doi: 10.1016/j.jhin.2006.07.008. PubMed PMID: 16978732. 4. Chiang H-Y, Kamath AS, Pottinger JM, Greenlee JDW, Howard Ma, Cavanaugh JE, Herwaldt La. Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy. Journal of neurosurgery. 2014;120:509-21. doi: 10.3171/2013.9.JNS13843. PubMed PMID: 24205908. 5. Buchanan CC, Hernandez EA, Anderson JM, Dye JA, Leung M, Buxey F, Bergsneider M, Afsar-Manesh N, Pouratian N, Martin NA. Analysis of 30-day readmissions among neurosurgical patients: surgical complication avoidance as key to quality improvement. Journal of neurosurgery. 2014;121:170-5. doi: 10.3171/2014.4.JNS13944. PubMed PMID: 24834942. 6. Shah MN, Stoev IT, Sanford DE, Gao F, Santiago P, Jaques DP, Dacey RG. Are readmission rates on a neurosurgical service indicators of quality of care? Journal of neurosurgery. 2013;119:1043-9. doi: 10.3171/2013.3.JNS121769. PubMed PMID: 23621593. 7. Edwards J, Peterson K, Mu Y. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. American journal of …. 2009. 8. United States. President (2009- : Obama), Obama B, United States. Office of Management and Budget. A new era of responsibility : renewing America's promise. Washington, D.C.: Executive Office of the President For sale by the Supt. of Docs., U.S. G.P.O.; 2009. 134 p. p. 9. Centers for M, Medicaid Services HHS. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule. Federal register. 2014;79(163):49853-50536. Epub 2014/08/30. PubMed PMID: 25167590. 10. Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: an overview. Effective clinical practice : ECP. 2002;5(3):143-51. PubMed PMID: 12088294. 11. Gerometta A, Rodriguez Olaverri JC, Bitan F. Infections in spinal instrumentation. International orthopaedics. 2012;36(2):457-64. doi: 10.1007/s00264-011-1426-0. PubMed PMID: 22218913; PMCID: 3282865. 12. Chaichana KL, Bydon M, Santiago-Dieppa DR, Hwang L, McLoughlin G, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham T. Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. Journal of neurosurgery Spine. 2014;20(1):45-52. doi: 10.3171/2013.10.SPINE1364. PubMed PMID: 24206038. 13. Hughey AB, Lesniak MS, Ansari SA, Roth S. What will anesthesiologists be anesthetizing? Trends in neurosurgical procedure usage. Anesthesia and analgesia. 2010;110(6):1686-97. doi: 10.1213/ANE.0b013e3181cbd9cc. PubMed PMID: 20142356. 14. Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 2010;31(12):1219-29. doi: 10.1086/657134. PubMed PMID: 20969449; PMCID: 3833867. 15. Stone HH. Basic principles in the use of prophylactic antibiotics. The Journal of antimicrobial chemotherapy. 1984;14 Suppl B:33-7. PubMed PMID: 6501134. 16. 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. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 2007;28(9):1047-53. doi: 10.1086/520731. PubMed PMID: 17932825. 17. Molinari RW, Khera OA, Molinari WJ, 3rd. Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2012;21 Suppl 4:S476-82. doi: 10.1007/s00586-011-2104-z. PubMed PMID: 22160172; PMCID: 3369056. 18. Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK. Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder. Spine. 2013;38(12):991-4. doi: 10.1097/BRS.0b013e318285b219. PubMed PMID: 23324930. 19. O'Neill KR, Smith JG, Abtahi AM, Archer KR, Spengler DM, McGirt MJ, Devin CJ. Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. The spine journal : official journal of the North American Spine Society. 2011;11(7):641-6. doi: 10.1016/j.spinee.2011.04.025. PubMed PMID: 21600853. 20. Sweet FA, Roh M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine. 2011;36(24):2084-8. doi: 10.1097/BRS.0b013e3181ff2cb1. PubMed PMID: 21304438. 21. Caroom C, Tullar JM, Benton EG, Jr., Jones JR, Chaput CD. Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion. Spine. 2013;38(14):1183-7. doi: 10.1097/BRS.0b013e31828fcfb5. PubMed PMID: 23474597. 22. Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V, Mathieu R. Reduction of sternal infection by application of topical vancomycin. The Journal of thoracic and cardiovascular surgery. 1989;98(4):618-22. PubMed PMID: 2796369. 23. Arruda MV, Braile DM, Joaquim MR, Suzuki FA, Alves RH. [The use of the vancomycin paste for sternal hemostasis and mediastinitis prophylaxis]. Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular. 2008;23(1):35-9. PubMed PMID: 18719826. 24. Korinek AM, Golmard JL, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L. Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. British journal of neurosurgery. 2005;19(2):155-62. doi: 10.1080/02688690500145639. PubMed PMID: 16120519. 25. Chiang YP, Chikwe J, Moskowitz AJ, Itagaki S, Adams DH, Egorova NN. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. Jama. 2014;312(13):1323-9. doi: 10.1001/jama.2014.12679. PubMed PMID: 25268439. 26. O'Keeffe AB, Lawrence T, Bojanic S. Oxford craniotomy infections database: a cost analysis of craniotomy infection. British journal of neurosurgery. 2012;26(2):265-9. doi: 10.3109/02688697.2011.626878. PubMed PMID: 22081956. 27. McClelland S, 3rd. Postoperative intracranial neurosurgery infection rates in North America versus Europe: a systematic analysis. American journal of infection control. 2008;36(8):570-3. doi: 10.1016/j.ajic.2007.07.015. PubMed PMID: 18926310. 28. Korinek A-M, Golmard J-L, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L. Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. British journal of neurosurgery. 2005;19:155-62. doi: 10.1080/02688690500145639. PubMed PMID: 16120519. 29. Walcott BP, Neal JB, Sheth Sa, Kahle KT, Eskandar EN, Coumans J-V, Nahed BV. The incidence of complications in elective cranial neurosurgery associated with dural closure material. Journal of neurosurgery. 2014;120:278-84. doi: 10.3171/2013.8.JNS13703. PubMed PMID: 24032702. 30. Khan NR, Thompson CJ, DeCuypere M, Angotti JM, Kalobwe E, Muhlbauer MS, Camillo FX, Klimo P, Jr. A meta-analysis of spinal surgical site infection and vancomycin powder. Journal of neurosurgery Spine. 2014;21(6):974-83. doi: 10.3171/2014.8.SPINE1445. PubMed PMID: 25259555. 31. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control. 2008;36(5):309-32. doi: 10.1016/j.ajic.2008.03.002. PubMed PMID: 18538699.

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