IMPORTANCE: Staphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies. OBJECTIVES: To assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study assessed surgical patients at 33 hospitals in 10 European countries who were recruited between December 16, 2016, and September 30, 2019 (follow-up through December 30, 2019). Enrolled patients were actively followed up for up to 90 days after surgery to assess the occurrence of S aureus SSIs and BSIs. Data analysis was performed between November 20, 2020, and April 21, 2022. All patients were 18 years or older and had undergone 11 different types of surgical procedures. They were screened for S aureus colonization in the nose, throat, and perineum within 30 days before surgery (source population). Both S aureus carriers and noncarriers were subsequently enrolled in a 2:1 ratio. EXPOSURE: Preoperative S aureus colonization. MAIN OUTCOMES AND MEASURES: The main outcome was cumulative incidence of S aureus SSIs and BSIs estimated for the source population, using weighted incidence calculation. The independent association of candidate variables was estimated using multivariable Cox proportional hazards regression models. RESULTS: In total, 5004 patients (median [IQR] age, 66 [56-72] years; 2510 [50.2%] female) were enrolled in the study cohort; 3369 (67.3%) were S aureus carriers. One hundred patients developed S aureus SSIs or BSIs within 90 days after surgery. The weighted cumulative incidence of S aureus SSIs or BSIs was 2.55% (95% CI, 2.05%-3.12%) for carriers and 0.52% (95% CI, 0.22%-0.91%) for noncarriers. Preoperative S aureus colonization (adjusted hazard ratio [AHR], 4.38; 95% CI, 2.19-8.76), having nonremovable implants (AHR, 2.00; 95% CI, 1.15-3.49), undergoing mastectomy (AHR, 5.13; 95% CI, 1.87-14.08) or neurosurgery (AHR, 2.47; 95% CI, 1.09-5.61) (compared with orthopedic surgery), and body mass index (AHR, 1.05; 95% CI, 1.01-1.08 per unit increase) were independently associated with S aureus SSIs and BSIs. CONCLUSIONS AND RELEVANCE: In this cohort study of surgical patients, S aureus carriage was associated with an increased risk of developing S aureus SSIs and BSIs. Both modifiable and nonmodifiable etiologic factors were associated with this risk and should be addressed in those at increased S aureus SSI and BSI risk.

AstraZeneca Plc Gaithersburg Maryland

AZ Sint Lucas Ziekenhuis Gent Campus Volkskliniek Gent Belgium

Azienda Ospedaliera Universitaria Ospedali Riuniti Ancona Italy

Central Military University Emergency Hospital Dr Carol Davila Bucharest Romania

Centre Hospitalier Universitaire de Limoges Limoges France

CIBERINFEC Instituto de Salud Carlos 3 Madrid Spain

Clinical Centre of Kragujevac Kragujevac Serbia

Clinical Centre of Serbia Belgrade Serbia

Department of Medical Microbiology University Medical Center Utrecht Utrecht University Utrecht the Netherlands

Department of Surgery Amphia Hospital Breda North Brabant the Netherlands

Department of Surgery Wilhelmina Ziekenhuis Assen Assen Drenthe the Netherlands

Elias Emergency University Hospital Bucharest Romania

Heilig Hart Hospital Lier Belgium

Hospital Brescia University of Brescia Brescia Italy

Hospital del Mar IMIM UPF Barcelona Spain

Hospital Universitario de Asturias Asturia Spain

Hospital Universitario de Bellvitge Barcelona Spain

Hospital Universitario Reina Sofía IMIBIC Cordoba Spain

Hospital Universitario Virgen Macarena Seville Spain

Infection Control Programme and World Health Organization Collaborating Center Geneva University Hospitals and Faculty of Medicine Geneva Switzerland

Institute for Orthopedic Surgery Banjica Belgrade Serbia

Institute of Medical Biometry and Statistics Faculty of Medicine and Medical Center University of Freiburg Freiburg Germany

Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca Romania

Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands

Laboratory of Medical Microbiology Vaccine and Infectious Disease Institute University of Antwerp Antwerp Belgium

Microbial Sciences R and D BioPharmaceuticals AstraZeneca Plc Gaithersburg Maryland

Motol University Hospital Prague Czechia

North Estonia Medical Centre Tallinn Estonia

North Manchester General Hospital Pennine Acute Hospitals NHS Trust Manchester England United Kingdom

ow with Gilead Sciences Inc Foster City California

Prof Dr C C Iliescu Institute for Emergency Cardiovascular Diseases Bucharest Romania

Queen Elizabeth Hospital Birmingham University Hospitals Birmingham National Health Service Foundation Trust Birmingham England United Kingdom

South Tees Hospitals NHS Foundation Trust Middlesbrough England United Kingdom

St Anne's University Hospital Brno Czechia

Tartu University Hospital Tartu Estonia

Timisoara County Hospital Timisoara Romania

University Hospital Hradec Králové Hradec Králové Czechia

University Hospital Ostrava Ostrava Poruba Czechia

University Hospitals of Derby and Burton NHS Foundation Trust Derby England United Kingdom

University Hospitals Sussex NHS Foundation Trust Brighton United Kingdom

University Medical Center Utrecht Utrecht University Utrecht the Netherlands

UOC Anestesia e Rianimazione Ospedale Infermi Rimini Italy

York and Scarborough Teaching Hospitals NHS Foundation Trust York England United Kingdom

JAMA Netw Open. 2024 Mar 4;7(3):e244564. doi: 10.1001/jamanetworkopen.2024.4564. PubMed

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