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    The epidemiology of Staphylococcus aureus transmission in the anesthesia work area

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    Authors
    Loftus, Randy W.
    Koff, Matthew D.
    Brown, Jeremiah R.
    Patel, Hetal M.
    Jensen, Jens T.
    Reddy, Sundara
    Ruoff, Kathryn L.
    Heard, Stephen O.
    Yeager, Mark P.
    Dodds, Thomas M.
    UMass Chan Affiliations
    Department of Anesthesiology
    Document Type
    Journal Article
    Publication Date
    2015-04-01
    Keywords
    Adult
    Aged
    Anesthesia
    Anesthesiology
    Anti-Bacterial Agents
    Cross Infection
    Drug Resistance, Bacterial
    Electrophoresis, Gel, Pulsed-Field
    Equipment Contamination
    Female
    Humans
    Male
    Microbial Sensitivity Tests
    Middle Aged
    Operating Rooms
    Phenotype
    Postoperative Period
    Prospective Studies
    Risk Factors
    Skin
    Staphylococcal Infections
    Staphylococcus aureus
    Time Factors
    Anesthesiology
    Clinical Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1213/ANE.0b013e3182a8c16a
    Abstract
    BACKGROUND: Little is known regarding the epidemiology of intraoperative Staphylococcus aureus transmission. The primary aim of this study was to examine the mode of transmission, reservoir of origin, transmission locations, and antibiotic susceptibility for frequently encountered S aureus strains (phenotypes) in the anesthesia work area. Our secondary aims were to examine phenotypic associations with 30-day postoperative patient cultures, phenotypic growth rates, and risk factors for phenotypic isolation. METHODS: S aureus isolates previously identified as possible intraoperative bacterial transmission events by class of pathogen, temporal association, and analytical profile indexing were subjected to antibiotic disk diffusion sensitivity. The combination of these techniques was then used to confirm S aureus transmission events and to classify them as occurring within or between operative cases (mode). The origin of S aureus transmission events was determined via use of a previously validated experimental model and links to 30-day postoperative patient cultures confirmed via pulsed-field gel electrophoresis. Growth rates were assessed via time-to-positivity analysis, and risk factors for isolation were characterized via logistic regression. RESULTS: One hundred seventy S aureus isolates previously implicated as possible intraoperative transmission events were further subdivided by analytical profile indexing phenotype. Two phenotypes, phenotype P (patients) and phenotype H (hands), accounted for 65% of isolates. Phenotype P and phenotype H contributed to at least 1 confirmed transmission event in 39% and 28% of cases, respectively. Patient skin surfaces (odds ratio [OR], 8.40; 95% confidence interval [CI], 2.30-30.73) and environmental (OR, 10.89; 95% CI, 1.29-92.13) samples were more likely than provider hands (referent) to have phenotype P positivity. Phenotype P was more likely than phenotype H to be resistant to methicillin (OR, 4.38; 95% CI, 1.59-12.06; P = 0.004) and to be linked to 30-day postoperative patient cultures (risk ratio, 36.63 [risk difference, 0.174; 95% CI, 0.019-0.328]; P < 0.001). Phenotype P exhibited a faster growth rate for methicillin resistant and for methicillin susceptible than phenotype H (phenotype P: median, 10.32H; interquartile range, 10.08-10.56; phenotype H: median, 10.56H; interquartile range, 10.32-10.8; P = 0.012). Risk factors for isolation of phenotype P included age (OR, 14.11; 95% CI, 3.12-63.5; P = 0.001) and patient exposure to the hospital ward (OR, 41.11; 95% CI, 5.30-318.78; P < 0.001). CONCLUSIONS: Two S aureus phenotypes are frequently transmitted in the anesthesia work area. A patient and environmentally derived phenotype is associated with increased risk of antibiotic resistance and links to 30-day postoperative patient cultures as compared with a provider hand-derived phenotype. Future work should be directed toward improved screening and decolonization of patients entering the perioperative arena and improved intraoperative environmental cleaning to attenuate postoperative health care-associated infections.
    Source
    Anesth Analg. 2015 Apr;120(4):807-18. doi: 10.1213/ANE.0b013e3182a8c16a. Link to article on publisher's site
    DOI
    10.1213/ANE.0b013e3182a8c16a
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/25759
    PubMed ID
    24937345
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1213/ANE.0b013e3182a8c16a
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