Poor functional status as a risk factor for surgical site infection due to methicillin-resistant Staphylococcus aureus
Poor functional status as a risk factor for surgical site infection due to methicillin-resistant Staphylococcus aureus
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DOI：
10.1086/590124
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发表时间：
2008-09-01
影响因子：
4.5
通讯作者：
Kaye, Keith S.
中科院分区：
文献类型：
--
作者：
Anderson, Deverick J.;Chen, Luke F.;Kaye, Keith S.
客观的。确定耐甲氧西林金黄色葡萄球菌 (MRSA) 导致手术部位感染 (SSI) 的危险因素。设计。前瞻性病例对照研究。设置。美国东南部一所高等教育机构和 6 所社区机构。方法。我们将 MRSA 引起的 SSI 患者与 2 个对照组进行了比较：匹配的未感染手术患者和甲氧西林敏感金黄色葡萄球菌 (MSSA) 引起的 SSI 患者。与每个对照组相比，使用多变量逻辑回归来确定与 MRSA 引起的 SSI 独立相关的变量。结果。在为期 5 年的研究期间，确定了 150 名因 MRSA 导致 SSI 的患者，并与 231 名匹配的未感染对照患者和 128 名因 MSSA 导致 SSI 的对照患者进行了比较。在两个多变量回归模型中，有两个变量与 MRSA 引起的 SSI 独立相关：需要 3 种或更多日常生活活动的帮助（比值比 [OR] 与未感染患者相比，3.97 [95% 置信区间 {CI}，2.18-7.25]；OR 与 MSSA 引起的 SSI 患者相比，3.88 [95% CI，1.91-7.87]）和手术时间延长（OR）与未感染患者相比，为 1.98 [95% CI，1.11-3.55]；或与 MSSA 引起的 SSI 患者相比，为 2.33 [95% CI，1.17-4.62]）。按年龄分层后，缺乏独立性（即功能状态不佳）仍然与 MRSA 导致的 SSI 风险增加相关。结论。在成年手术患者中，无论年龄如何，功能状态不佳与 MRSA 引起的 SSI 高度相关。可以轻松确定患者的独立程度，并且可以在术前使用该信息来制定预防性干预措施。
Objective. To identify risk factors for surgical site infection (SSI) due to methicillin-resistant Staphylococcus aureus (MRSA).Design. Prospective case-control study.Setting. One tertiary and 6 community-based institutions in the southeastern United States.Methods. We compared patients with SSI due to MRSA with 2 control groups: matched uninfected surgical patients and patients with SSI due to methicillin-susceptible S. aureus (MSSA). Multivariable logistic regression was used to determine variables independently associated with SSI due to MRSA, compared with each control group.Results. During the 5-year study period, 150 case patients with SSI due to MRSA were identified and compared with 231 matched uninfected control patients and 128 control patients with SSI due to MSSA. Two variables were independently associated with SSI due to MRSA in both multivariable regression models: need for assistance with 3 or more activities of daily living (odds ratio [OR] compared with uninfected patients, 3.97 [95% confidence interval {CI}, 2.18-7.25]; OR compared with patients with SSI due to MSSA, 3.88 [95% CI, 1.91-7.87]) and prolonged duration of surgery (OR compared with uninfected patients, 1.98 [95% CI, 1.11-3.55]; OR compared with patients with SSI due to MSSA, 2.33 [95% CI, 1.17-4.62]). Lack of independence (ie, poor functional status) remained associated with an increased risk of SSI due to MRSA after stratifying by age.Conclusions. Poor functional status was highly associated with SSI due to MRSA in adult surgical patients, regardless of age. A patient's level of independence can be easily determined, and this information can be used preoperatively to target preventive interventions.