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Pathogens Implicated in SSIs Following Breast Surgeries in Ambulatory Surgery Centers, United States, 2012-2018

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      Background

      Operative procedures performed in Ambulatory Surgery Centers (ASCs) are increasing in frequency and complexity in the United States, but national-level data on the incidence and characteristics of surgical site infections (SSIs) following these procedures are limited. Among the ASC operative procedures under SSI surveillance via a national healthcare-associated infection tracking system, breast surgeries (BRST) are the highest volume and pose the highest SSI risk. To further characterize SSIs following ASC BRST, we analyzed the surveillance data describing the pathogens implicated in these infections.

      Methods

      We analyzed BRST SSI data submitted by ASCs from 2012 to 2018. Up to three pathogens are reportable per SSI. SSI pathogen susceptibility results were reported as susceptible, intermediate, resistant, or not tested and patterns identified. Only pathogens reported with susceptibility results were included in the study.

      Results

      Among the 101,277 breast surgeries reported by 167 ASCs to the tracking system 246 BRST SSIs were identified, an average of 35 infections per year. Pathogens and antibiotic susceptibility results were submitted for 152 (61%) of the 246 SSIs. Among the 163 pathogens reported, the most common were Staphylococcus aureus (SA), Pseudomonas aeruginosa (PA) and Serratia marcescens (SM), 82 (50.31%), 13 (7.98%), and 10 (6.13%) respectively. Among the SA pathogens identified, 20 (26.67%) were methicillin-resistant (MRSA).

      Conclusions

      This is the first study of pathogen distribution among SSIs reported by ASCs from the tracking system, and the findings demonstrate that for a high volume surgical procedure, microbiology results are available for most reported infections, often including the antimicrobial susceptibilities of the implicated pathogens. The tracking system's expanding role in ASC SSI surveillance includes opportunities for more comprehensive geographic coverage of SSIs and, when additional data are available, analysis of variations in infection incidence and pathogen distribution by time and place.
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