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April 3, 2013

Preventing Postoperative Staphylococcus aureus Infections: The Search Continues

Author Affiliations

Author Affiliations: Divisions of Infectious Diseases and Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Veterans Affairs, Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, Ann Arbor. Dr Malani is also Contributing Editor, JAMA.

JAMA. 2013;309(13):1408-1409. doi:10.1001/jama.2013.3382

Among carefully selected patients, cardiac surgery can enhance both quality and duration of life. Today, procedures such as coronary artery bypass graft surgery (CABG) and valve replacement/repair are commonplace, with more than 400 000 median sternotomies for these and other procedures performed annually in the United States.1 Despite the potential benefits, infectious complications remain a significant source of postoperative morbidity, with Staphylococcus aureus infections topping the list2-4; in the setting of a new valve or endograft, such infections are associated with case-fatality rates of nearly 50%.5 For patients who develop serious staphylococcal infections after cardiac surgery, any operative benefit can be negated by a complex and lengthy postoperative treatment course involving additional procedures (debridement, flap closure) and extended therapy with parenteral antimicrobials. Given the enormous adverse consequences of infectious complications on surgical outcomes, prevention efforts grounded in the best evidence remain essential.