Abstract
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.
Keywords
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