A note in the medical record indicates that a patient acquired a Staphylococcus aureus infection in the hospital following spinal surgery. The patient is instructed to remain on a low dose oral antibiotic despite already completing 35 days of intravenous antibiotic therapy. Which surgical scenario is MOST consistent with this scenario?

• A. Healing by primary intention
• B. Postoperative immobilization
• C. Overnight hospitalization
• D. Internal fixation

Answer: (C)

Hospital-acquired infections are a risk whenever a patient stays in the hospital after surgery. Staphylococcus aureus is a common culprit in the inpatient setting, and an infection that requires an extended course of intravenous antibiotics, with a plan to continue a low-dose oral antibiotic afterward, points to a deep or hardware-associated infection acquired during the hospital stay. The fact that the note specifies the infection was acquired in the hospital makes the factor of overnight postoperative hospitalization the most consistent scenario, since being admitted for observation or care after surgery provides the exposure necessary for a nosocomial infection. The other options describe aspects of wound healing or postoperative care, not the inpatient exposure that led to the infection.