Risk prediction for Staphylococcus aureus surgical site infection following cardiothoracic surgery; A secondary analysis of the V710-P003 trial

Autor: Hasan S. Jafri, Kristin Ohneberg, Karina Olsen, Fleur P Paling, Frangiscos Sifakis, Martin Wolkewitz, Vance G. Fowler, Jan Kluytmans, Mark J. DiNubile, Stéphan Juergen Harbarth, Marc J. M. Bonten
Jazyk: angličtina
Rok vydání: 2018
Předmět:
0301 basic medicine
Bacterial Diseases
Male
Cardiovascular Procedures
Staphylococcus
Coronary artery bypass grafting
lcsh:Medicine
Bacteremia
medicine.disease_cause
Pathology and Laboratory Medicine
0302 clinical medicine
Endocrinology
Mathematical and Statistical Techniques
Diabetes mellitus
Risk Factors
Staphylococcal Vaccines/therapeutic use
Medicine and Health Sciences
030212 general & internal medicine
Prospective Studies
Prospective cohort study
lcsh:Science
Surgical and invasive medical procedures
ddc:616
Vaccines
Multidisciplinary
Surgical Wound Infection/diagnosis/microbiology/prevention & control
Vaccination
Staphylococcal Vaccines
Staphylococcal Infections
Middle Aged
Bacterial Pathogens
Infectious Diseases
Staphylococcus aureus
Cardiothoracic surgery
Medical Microbiology
Physical Sciences
Female
Pathogens
Statistics (Mathematics)
Research Article
Adult
medicine.medical_specialty
Infectious Disease Control
Endocrine Disorders
Cardiovascular Surgical Procedures/adverse effects
030106 microbiology
Staphylococcal infections
Research and Analysis Methods
Microbiology
03 medical and health sciences
Double-Blind Method
Internal medicine
medicine
Staphylococcus aureus/pathogenicity
Surgical Wound Infection
Humans
Statistical Methods
Microbial Pathogens
Aged
Bacteria
business.industry
Cardiovascular Surgical Procedures
lcsh:R
Organisms
Biology and Life Sciences
Staphylococcal Infections/diagnosis/microbiology/prevention & control
medicine.disease
Confidence interval
Clinical trial
Metabolic Disorders
lcsh:Q
business
Mathematics
Forecasting
Zdroj: PLoS ONE, Vol 13, Iss 3, p e0193445 (2018)
PLoS ONE [E], 13(3). Public Library of Science
PLOS ONE, Vol. 13, No 3 (2018) P. e0193445
PLoS ONE
ISSN: 1932-6203
Popis: Background Identifying patients undergoing cardiothoracic surgery at high risk of Staphylococcus aureus surgical site infection (SSI) is a prerequisite for implementing effective preventive interventions. The objective of this study was to develop a risk prediction model for S. aureus SSI or bacteremia after cardiothoracic surgery based on pre-operative variables. Materials/Methods Data from the Merck Phase IIb/III S. aureus vaccine (V710-P003) clinical trial were analyzed. In this randomized placebo-controlled trial, the effect of preoperative vaccination against S. aureus was investigated in patients undergoing cardiothoracic surgery. The primary outcome was deep/superficial S. aureus SSI or S. aureus bacteremia through day 90 after surgery. Performance, calibration, and discrimination of the final model were assessed. Results Overall 164 out of 7,647 included patients (2.1%) developed S. aureus infection (149 SSI, 15 bacteremia, 28 both). Independent risk factors for developing the primary outcome were pre-operative colonization with S. aureus (OR 3.08, 95% confidence interval [CI] 2.23–4.22), diabetes mellitus (OR 1.87, 95% CI 1.34–2.60), BMI (OR 1.02 per kg/m2, 95% CI 0.99–1.05), and CABG (OR 2.67, 95% CI 1.91–3.78). Although vaccination had a significant (albeit modest) protective effect, it was omitted from the model because its addition did not significantly change the coefficients of the final model and V710-vaccine development has been discontinued due to insufficient efficacy. The final prediction model had moderate discriminative accuracy (AUC-value, 0.72). Conclusion Pre-operative S. aureus colonization status, diabetes mellitus, BMI, and type of surgical procedure moderately predicted the risk of S. aureus SSI and/or bacteremia among patients undergoing cardiothoracic surgery.
Databáze: OpenAIRE
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