Background
Evidence-based intraoperative infection control measures can reduce Staphylococcus aureus transmission and infections. We aimed to determine whether transmitted S. aureus isolates were associated with increased risk of multidrug resistance and associated
traits.
Methods
S. aureus isolates obtained from intraoperative environmental, patient skin, and provider hand
reservoirs among 274 operating room case pairs (1st and 2nd case of the day) across 3 major academic medical centers from March 2009 to February
2010 underwent systematic-phenotypic-genomic analysis to identify clonal transmission
events. The association of clonal S. aureus transmission with multidrug resistance and resistance traits was investigated. Transmission
dynamics were characterized.
Results
Transmitted isolates (N=58) were associated with increased risk of multi-drug antibiotic
resistance [33% (19/58) transmitted vs. 10% (12/115) other isolates, risk ratio 3.14,
99% CI 1.34-7.38, P=0.0006]. Transmission was associated with a significant increase in resistance traits
including mecA [40% transmitted isolates vs. 17% other isolates, risk ratio 2.28,
P=0.0026] and ant (6)-Ia [26% transmitted isolates vs. 9% other isolates, risk ratio
2.97, P=0.0050]. Provider hands were a frequent reservoir of origin, between-case a common
mode of transmission, and patient skin and provider hands frequent transmission locations
for multidrug resistant pathogens.
Conclusions
Intraoperative S. aureus transmission was associated with multidrug resistance and resistance traits. Proven
infection control measures should be leveraged to target intraoperative transmission
of multidrug resistant pathogens.
Key Words
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Article Info
Publication History
Published online: August 01, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: Anesthesia Patient Safety Foundation (APSF), Dartmouth (National Institutes of Health (NIH) Application 1 R01 AI155752-01A1), entitled: The BASIC trial: Improving implementation of evidence-based approaches and surveillance to prevent bacterial transmission and infection.
Conflicts of Interest Statement: RWL received research funding from Sage Medical Inc., BBraun, Draeger, Surfacide and Kenall, has one or more patents pending, and is a partner of RDB Bioinformatics, LLC, and 1055 N 115th St #301 (Omaha, NE, USA) a company that owns OR PathTrac, and has spoken at educational meetings sponsored by Kenall (AORN) and BBraun (APIC). FD is Director of the Division of Management Consulting of the University of Iowa Department of Anesthesia, which provides consultations to corporations, hospitals, and individuals. He receives no funds personally other than his salary and allowable expense reimbursements from the University of Iowa. His family and he have no financial holdings in any company related to his work. A list of all the Division's consults is available in his posted curriculum vitae at FranklinDexter.net/Contact_Info.htm. Other authors are without disclosures
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© 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
