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

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Abstract: 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

Location
Deutsche Nationalbibliothek Frankfurt am Main
Extent
Online-Ressource
Language
Englisch
Notes
PLOS ONE. - 13, 3 (2018) , e0193445, ISSN: 1932-6203

Event
Veröffentlichung
(where)
Freiburg
(who)
Universität
(when)
2019
Creator
Paling, Fleur P.
Olsen, Karina
Ohneberg, Kristin
Wolkewitz, Martin
Fowler, Vance G.
DiNubile, Mark J.
Jafri, Hasan S.
Sifakis, Frangiscos
Bonten, Marc J. M.
Harbarth, Stephan
Kluytmans, Jan A. J. W.

DOI
10.1371/journal.pone.0193445
URN
urn:nbn:de:bsz:25-freidok-1468380
Rights
Kein Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
Last update
15.08.2025, 7:36 AM CEST

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Time of origin

  • 2019

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