[Skip to Content]
[Skip to Content Landing]
Views 109
Citations 0
Comment & Response
April 8, 2020

Implications of Postoperative Infections on Long-term Outcomes—Reply

Author Affiliations
  • 1VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts
  • 2VA Boston Department of Medicine, Boston, Massachusetts
  • 3Boston University School of Medicine, Boston, Massachusetts
  • 4VA Boston Department of Surgery, Boston, Massachusetts
  • 5Harvard Medical School, Boston, Massachusetts
JAMA Surg. Published online April 8, 2020. doi:10.1001/jamasurg.2020.0419

In Reply We appreciate the comments from Chen et al regarding long-term outcomes in surgical patients with 30-day postoperative infections.1 The authors are concerned that the inclusion of blood cultures that represent contamination rather than true infection may undermine the robustness of our conclusions. Fortunately, this is an issue that has been well addressed in previous literature and by the US Centers for Disease Control and Prevention.2,3 A laboratory-confirmed bloodstream infection requires 1 positive blood culture with a recognized pathogen and more than 2 blood cultures for organisms that colonize the skin, most commonly coagulase negative staphylococci. Most pathogens in our bloodstream infection outcome were Staphylococcus aureus or gram-negative organisms; these clearly are considered pathogenic and true infections. Coagulase negative staphylococci were isolated in 38% of bloodstream infection outcomes. When we eliminated these from the cohort, our results were similar, with a 3.19 hazard ratio (95% CI, 3.08-3.31). This is not surprising because most of our pathogens were true pathogens and the number of bloodstream infections was low compared with other infection types.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×