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The Importance of Targeting Intraoperative Transmission of Bacteria with Antibiotic Resistance and Strain Characteristics
Journal article   Peer reviewed

The Importance of Targeting Intraoperative Transmission of Bacteria with Antibiotic Resistance and Strain Characteristics

Randy W Loftus, Franklin Dexter and Jeremiah Brown
American journal of infection control, Vol.51(6), pp.612-618
06/2023
DOI: 10.1016/j.ajic.2022.07.024
PMCID: PMC10918765
PMID: 35926685
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC10918765/pdf/nihms-1876385.pdfView
Open Access

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.

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