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Staphylococcus aureus bacteremia in the surgical patient: a prospective analysis of 73 postoperative patients who developed Staphylococcus aureus bacteremia at a tertiary care facility.

Publication ,  Journal Article
Gottlieb, GS; Fowler, VG; Kong, LK; McClelland, RS; Gopal, AK; Marr, KA; Li, J; Sexton, DJ; Glower, D; Corey, GR
Published in: J Am Coll Surg
January 2000

BACKGROUND: Staphylococcus aureus is a frequent cause of infection and bacteremia in the postoperative patient. Unfortunately, there have been no prospective studies evaluating these patients, so the incidence of complications, subsequent treatment algorithms, and prognosis remain undefined. The objectives of this prospective study of postoperative Staphylococcus aureus bacteremia (SAB) were to define the primary sources of bacteremia and to identify the common complications of SAB in the postoperative setting. METHODS: A registry was developed into which 309 consecutive adult patients with SAB were prospectively enrolled between September 1994 and December 1996. Seventy-three of these patients (23.6%) developed SAB in the postoperative setting. RESULTS: Analysis of the clinical features of these 73 postoperative patients revealed three important results. First, infective endocarditis is surprisingly common in postoperative patients with SAB and the classical stigmata of endocarditis are often absent. Transesophageal echocardiography was performed in 31 of 73 patients; 10 of these patients (32.3%) met Duke Criteria for definite endocarditis, but only 3 of these patients had vegetations detected by transthoracic echocardiography, and only 2 patients had peripheral stigmata of infective endocarditis. Second, the development of SAB after cardiothoracic surgery was strongly associated with underlying S. aureus mediastinitis. Twenty-one of the 23 patients who developed SAB after median sternotomy had mediastinitis (positive predictive value 91.3%). In many cases, the diagnosis of mediastinitis was not apparent when SAB was detected. Third, complications, relapses, and mortality were high in postoperative patients with SAB. Fourteen of 73 patients (19.2%) developed multiple noncardiac metastatic complications, including metastatic abscesses (5), septic emboli (3), pneumonia or empyema (2), septic arthritis (1), epidural abscess (1), and other metastatic foci (7). Twelve of 73 patients (16.4%) had recurrent staphylococcal infection after treatment of their first episode of SAB, including 8 patients (11.0%) with recurrent bacteremia. Of patients who survived, those with recurrent staphylococcal infection were more likely to have an infected surgical wound than were patients who were cured of infection (p = 0.05). Finally, mortality attributable to SAB (11.0%), and all-cause mortality (21.9%), was high. CONCLUSIONS: SAB in the postoperative setting is often a severe disease with high morbidity and mortality. A thorough diagnostic evaluation is indicated in surgical patients with S. aureus bacteremia to ensure the early detection of metastatic infections such as infective endocarditis and to define foci such as mediastinitis re quiring surgical intervention.

Duke Scholars

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

January 2000

Volume

190

Issue

1

Start / End Page

50 / 57

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgical Wound Infection
  • Surgery
  • Staphylococcal Infections
  • Registries
  • Prospective Studies
  • Morbidity
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Gottlieb, G. S., Fowler, V. G., Kong, L. K., McClelland, R. S., Gopal, A. K., Marr, K. A., … Corey, G. R. (2000). Staphylococcus aureus bacteremia in the surgical patient: a prospective analysis of 73 postoperative patients who developed Staphylococcus aureus bacteremia at a tertiary care facility. J Am Coll Surg, 190(1), 50–57. https://doi.org/10.1016/s1072-7515(99)00211-2
Gottlieb, G. S., V. G. Fowler, L. K. Kong, R. S. McClelland, A. K. Gopal, K. A. Marr, J. Li, D. J. Sexton, D. Glower, and G. R. Corey. “Staphylococcus aureus bacteremia in the surgical patient: a prospective analysis of 73 postoperative patients who developed Staphylococcus aureus bacteremia at a tertiary care facility.J Am Coll Surg 190, no. 1 (January 2000): 50–57. https://doi.org/10.1016/s1072-7515(99)00211-2.
Gottlieb, G. S., et al. “Staphylococcus aureus bacteremia in the surgical patient: a prospective analysis of 73 postoperative patients who developed Staphylococcus aureus bacteremia at a tertiary care facility.J Am Coll Surg, vol. 190, no. 1, Jan. 2000, pp. 50–57. Pubmed, doi:10.1016/s1072-7515(99)00211-2.
Gottlieb GS, Fowler VG, Kong LK, McClelland RS, Gopal AK, Marr KA, Li J, Sexton DJ, Glower D, Corey GR. Staphylococcus aureus bacteremia in the surgical patient: a prospective analysis of 73 postoperative patients who developed Staphylococcus aureus bacteremia at a tertiary care facility. J Am Coll Surg. 2000 Jan;190(1):50–57.
Journal cover image

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

January 2000

Volume

190

Issue

1

Start / End Page

50 / 57

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgical Wound Infection
  • Surgery
  • Staphylococcal Infections
  • Registries
  • Prospective Studies
  • Morbidity
  • Middle Aged
  • Male
  • Humans