Abstract
BACKGROUND: Increasing antibiotic resistance among Staphylococcus aureus (S. aureus) isolates is associated with increased worldwide mortality.Perioperative S. aureus transmission is tightly associated with surgical site infection development. Surgical site infections are associated with increased risk of patient mortality, hospital duration, readmission, and increased healthcare expenditure. S. aureus multilocus sequence types 5, 8, 105, 30, 59, 72, 188, and 256 are associated with increased risk of the spread of antibiotic resistance between operating rooms on different dates of surgery. In this study, we examined the association of S. aureus multilocus sequence types 5, 8, 105, 30, 59, 72, 188, and 256 with 30-day postoperative healthcare-associated infections and postoperative patient cultures obtained for workup of infection. METHODS: Anesthesia workspace reservoirs were previously sampled among 274 case-pairs at three major academic medical centers in the United States. Clonal S. aureus transmission was confirmed with whole genome analysis, and patients were followed prospectively for 30-day postoperative healthcare-associated infection development and culture acquisition for workup of infection. The potential association between S. aureus multilocus sequence types 5, 8, 105, 30, 59, 72, 188, and 256 detection and clonal transmission with 30-day postoperative healthcare-associated infection and/or patient culture for workup of infection vs. all other anesthesia workspace bacterial isolates was assessed. RESULTS: Of all anesthesia reservoir isolates, 6% (717/11,664) were associated with healthcare-associated infections and/or postoperative patient cultures. S. aureus multilocus sequence types 5, 8, 105, 30, 59, 72, 188, and 256 were associated with greater odds of healthcare-associated infection and/or postoperative culture than other isolates (32% (39/123) of S. aureus multilocus sequence types 5, 8, 105, 30, 59, 72, 188, and 256 vs. 6% (678/11,541) other isolates; adjusted odds ratio = 7.45, 95% CI = 3.59-15.46, P < 0.0001). Clonally transmitted S. aureus multilocus sequence types 5, 8, 105, 30, 59, 72, 188, and 256 were associated with increased risk of healthcare-associated infection and/or culture vs. other isolates (44% (8/18) S. aureus multilocus sequence types 5, 8, 105, 30, 59, 72, 188, and 256 vs. 6% (709/11,646) other isolates; adjusted odds ratio = 14.36, 97.5% CI = 3.14-65.62, P = 0.0002). CONCLUSION: Detection and clonal transmission of S. aureus multilocus sequence types 5, 8, 105, 30, 59, 72, 188, and 256 among anesthesia workspace reservoirs are associated with greater odds of 30-day postoperative healthcare-associated infection development and/or patient cultures vs. other anesthesia workspace isolates.