Highlights
- •Staphylococcus aureus pathogens are frequently transmitted in the operating room environment.
- •Methicillin-resistant S aureus is more transmissible than methicillin-sensitive S aureus.
Background
Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogenic S aureus strain characteristic associated with increased patient morbidity and mortality.
The health care system needs to understand MRSA transmissibility in all settings to
improve basic preventive measures to generate sustained reductions in invasive MRSA
infections. Our primary aim was to compare intraoperative transmissibility of MRSA
versus methicillin-sensitive S aureus (MSSA) isolates.
Methods
S aureus isolates (N = 173) collected from 274 randomly selected operating room environments
(first and second case of the day in each operating room, a case pair) at 3 hospitals
underwent systematic-phenotypic and genomic processing to identify clonally related
transmission events. Confirmed transmission events were defined as at least 2 S aureus isolates obtained from ≥2 distinct intraoperative reservoirs sampled within or between
cases in a study unit that were epidemiologically and clonally related. We explored
the relationship between clonal transmission and methicillin resistance with Poisson
regression analysis.
Results
We identified 58 clonal transmission events. MRSA isolates were associated with increased
risk of clonal transmission compared with MSSA isolates (adjusted incidence risk ratio
[IRR], 1.68; 95% confidence interval [CI], 1.13-2.49; P = .010; unadjusted IRR, 1.85; 95% CI, 1.23-2.77; P = .003, respectively).
Conclusions
MRSA isolates are associated with increased risk of intraoperative transmission. Future
work should examine the impact of the attenuation of intraoperative MRSA transmission
on the incidence of invasive MRSA infections.
Key Words
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Article info
Publication history
Published online: January 04, 2018
Footnotes
Funding/support: Supported by The University of Iowa.
Conflicts of interest: R.W.L. reports research funding from Sage Medical, has ≥1 patents pending, and is a shareholder in RDB Bioinformatics. A.D.M.R. and F.D. have no conflicts of interest.
Author contributions: R.W.L. helped design the study, conduct the study, analyze the data, and write the manuscript. F.D. helped analyze the data and write the manuscript. A.D.M.R. helped conduct the study. All authors approved the final version of the manuscript.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
