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Enterobateriaceae surpasses MRSA as leading cause of surgical site infections in UK
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DALLAS — Methicillin-resistant Staphylococcus aureus is no longer the leading cause of surgical site infections in the United Kingdom, but Enterobacteriaceae has gradually increased since 2007 and now accounts for most surgical site infections there.
“The changing etiology of surgical site infections may have implications for reassessing antimicrobial prophylaxis choice during surgical procedures,” according to Suzanne Elgohari, MSc, of the health care-associated infections and antimicrobial resistance department of the Health Protection Agency in London, and colleagues.
Elgohari and colleagues examined data on surgical site infections (SSIs) and assessed changes in the epidemiology of pathogens using National Surveillance Data pooled by National Health Service hospitals in the United Kingdom between 2000 and 2009. Data on 539,877 operations were submitted from 244 hospitals, of which 11,324 developed SSIs. Valid organism data were available for 77%; 27% had multiple causative organisms.
Significant decreases were observed in SSIs caused by methicillin-resistant Staphylococcus aureus (MRSA) between 2007 and 2008, and between 2008 and 2009. Enterobacteriaceae surpassed MRSA as the leading cause of SSIs for all categories between 2007 and 2009 (21% of all SSIs). In particular, E. coli increased by 16%, Proteus spp. by 8%, E. cloacae by 5% and Klebsiella spp. by 5%.
Compared with a 20% increase in the proportion of SSIs due to Enterobacteriaceae during 2007, the proportion increased by 25% and by 29% during 2008.
Moreover, Enterobacteriacea was the most common cause of SSIs after spinal surgery (29%), small bowel surgery (31%), coronary artery bypass surgery (33%) and large bowel surgery (34%), according to the researchers.
“MRSA reduction was apparent in each of the four categories, including coronary artery bypass graft surgery, large bowel, hip prosthesis and knee prosthesis,” Elgohari said. “The changes of the etiology of SSIs may mean that we need to reassess local policy and choice of antibiotic prophlyaxis and focus on local resistance issues according to the guidelines.” – by Ashley DeNyse
Reference:
- Elgohari S, et al. Enterobateriaceae replacing MRSA as the leading causative organism of surgical site infections in England: analysis of trends 2000-2009. #622. Presented at the Society for Healthcare Epidemiology in America. 2011 Annual Scientific Meeting. April 1-4. Dallas.
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