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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. 2020;155(7):668. 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.

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