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An Outbreak of Coagulase-Negative Staphylococcal Surgical-Site Infections Following Aortic Valve Replacement

Published online by Cambridge University Press:  02 January 2015

Rebecca L. Lark ,
Kristi VanderHyde ,
G. Michael Deeb ,
Steve Dietrich ,
Jeffrey P. Massey  and
Carol Chenoweth
Rebecca L. Lark
Affiliation:
Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
Kristi VanderHyde
Affiliation:
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
G. Michael Deeb
Affiliation:
Michigan Department of Community Health Laboratories, Division of Infectious Diseases, Lansing, Michigan
Steve Dietrich
Affiliation:
Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Jeffrey P. Massey
Affiliation:
Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Carol Chenoweth*
Affiliation:
Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
*
Division of Infectious Diseases, University of Michigan Health System, 1500 E Medical Center Dr, Room 3116 TC, Ann Arbor, MI 48109-4378
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Abstract

Objectives:

To determine the cause of a coagulase-negative staphylococcal outbreak and to identify risk factors for surgical-site infections among patients following Medtronic Freestyle bioprosthesis implantation.

Design:

Retrospective case-control study.

Setting:

An 800-bed university referral center.

Patients:

The cohort of 64 patients undergoing Freestyle valve replacement from September 1998 to December 1998.

Results:

Seven patients developed infection (10.9% vs 1.1% during the preceding 8 months), including two with mediastinals and five with endocarditis. There were no statistically significant differences between cases and controls with respect to age, gender, weight, underlying illness, preoperative hospital stay, duration of surgery, time on bypass, central venous catheter duration, National Nosocomial Infection Surveillance risk index, New York Heart Association class, albumin, or antibiotic prophylaxis. However, only three cases were documented to have received vancomycin prophylaxis. Of all staff evaluated, only surgical resident A was significantly associated with infection (odds ratio, 7.68; 95% confidence interval, 1.3-44.1; P=.02) Pulsed-field gel electrophoresis patterns on Staphylococcus epidermidis isolates from four of the six cases were identical. These cases were performed on different days. Surgical resident A was the only staff member present in the operating room for all cases caused by the epidemic strain. This S epidermidis strain, however, was not isolated from operating room staff.

Conclusion:

A surgical resident was significantly associated with infection. However, the cause of this outbreak was likely multifactorial. Changes occurring during the investigation included institution of vancomycin as routine prophylaxis and modification of surgical technique, which contributed to the resolution of the outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 10 , October 2001 , pp. 618 - 623
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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