J Pediatr Infect Dis 2021; 16(04): 160-165
DOI: 10.1055/s-0041-1726469
Original Article

Risk Factors for Surgical Site Infections in Pediatric General Surgery: A Case–Control Study

1   King Saud University Medical City & College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Tariq I. Altokhais
2   Department of Surgery, Division of Pediatric Surgery, King Saud University Medical City & College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
1   King Saud University Medical City & College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
1   King Saud University Medical City & College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
1   King Saud University Medical City & College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
1   King Saud University Medical City & College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Helmi M. H. Alsweirki
1   King Saud University Medical City & College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Abdulrahman Albassam
2   Department of Surgery, Division of Pediatric Surgery, King Saud University Medical City & College of Medicine, King Saud University, Riyadh, Saudi Arabia
› Institutsangaben
Funding The authors extend their appreciation to the Deanship of Scientific Research at King Saud University for funding this work through the Undergraduate Student's Research Support Program, project number (URSP-4-19-60).

Abstract

Objective Despite being the most common postoperative complication and having associated morbidity and mortality that increase health care costs, surgical site infection (SSI) has not received adequate attention and deserves further study. Previous reports in children were limited to SSI in certain populations. We conducted this retrospective case–control study to determine the incidence and possible risk factors for SSI following pediatric general surgical procedures.

Methods This was a retrospective case–control matched cohort study of all patients aged 0 to 14 years who underwent pediatric general surgical procedures between June 2015 and July 2018. The electronic medical records were searched for a diagnosis of SSI. Control subjects were randomly selected at a 4:1 ratio from patients who underwent identical procedures. Multiple risk factors were evaluated by bivariate analysis and multivariable conditional logistic regression.

Results A total of 1,520 patients underwent a general pediatric procedure during the study period, and of these, 47 (3.09%) developed SSIs. A bivariate analysis showed that patients with SSIs were younger, were admitted to the neonatal intensive care unit/pediatric intensive care unit (NICU/PICU) preoperatively, were more severely ill as measured by the ASA classification, underwent multiple procedures, had more surgical complications, and were transferred to the NICU/PICU postoperatively. A multivariate analysis identified four independent predictors of SSI: age, preoperative NICU/PICU admission, number of procedures, and ASA classification.

Conclusion Younger children with preoperative admission to the NICU/PICU, those who underwent multiple procedures and those who were severely ill as measured by their ASA classification were significantly more likely to develop SSIs.



Publikationsverlauf

Eingereicht: 09. Oktober 2020

Angenommen: 22. Februar 2021

Artikel online veröffentlicht:
14. April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Magill SS, Hellinger W, Cohen J. et al. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infect Control Hosp Epidemiol 2012; 33 (03) 283-291
  • 2 Gerber JS, Ross RK, Szymczak JE. et al. Infections after pediatric ambulatory surgery: Incidence and risk factors. Infect Control Hosp Epidemiol 2019; 40 (02) 150-157
  • 3 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20 (04) 250-278 , quiz 279–280
  • 4 Bucher BT, Guth RM, Elward AM. et al. Risk factors and outcomes of surgical site infection in children. J Am Coll Surg 2011; 212 (06) 1033-1038.e1
  • 5 Uludag O, Rieu P, Niessen M, Voss A. Incidence of surgical site infections in pediatric patients: a 3-month prospective study in an academic pediatric surgical unit. Pediatr Surg Int 2000; 16 (5-6): 417-420
  • 6 Bruny JL, Hall BL, Barnhart DC. et al. American college of surgeons national surgical quality improvement program pediatric: a beta phase report. J Pediatr Surg 2013; 48 (01) 74-80
  • 7 Doig CM, Wilkinson AW. Wound infection in a children's hospital. Br J Surg 1976; 63 (08) 647-650
  • 8 Sharma LK, Sharma PK. Postoperative wound infection in a pediatric surgical service. J Pediatr Surg 1986; 21 (10) 889-891
  • 9 Togo A, Coulibaly Y, Dembélé BT. et al. Risk factors for surgical site infection in children at the teaching hospital Gabriel Touré, Bamako. J Hosp Infect 2011; 79 (04) 371-372
  • 10 Ameh EA, Mshelbwala PM, Nasir AA. et al. Surgical site infection in children: prospective analysis of the burden and risk factors in a sub-Saharan African setting. Surg Infect (Larchmt) 2009; 10 (02) 105-109
  • 11 Centers for Disease Control and Prevention. Surgical site infection event. Propcedure Assoc Modul. . Accessed January 9, 2020 at: https://apic.org/Resource_/TinyMceFileManager/Academy/ASC_101_resources/Surveillance_NHSN/NHSN_9pscSSIcurrent_jan2015.pdf
  • 12 American Society of Anesthesiologists. The ASA classification of physical status. Accessed October, 2019 at: www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system
  • 13 Segal I, Kang C, Albersheim SG, Skarsgard ED, Lavoie PM. Surgical site infections in infants admitted to the neonatal intensive care unit. J Pediatr Surg 2014; 49 (03) 381-384
  • 14 Vu LT, Vittinghoff E, Nobuhara KK, Farmer DL, Lee H. Surgical site infections in neonates and infants: is antibiotic prophylaxis needed for longer than 24 h?. Pediatr Surg Int 2014; 30 (06) 587-592
  • 15 Woldemicael AY, Bradley S, Pardy C, Richards J, Trerotoli P, Giuliani S. Surgical site infection in a tertiary neonatal surgery centre. Eur J Pediatr Surg 2019; 29 (03) 260-265
  • 16 Mayon-White RT, Ducel G, Kereselidze T, Tikomirov E. An international survey of the prevalence of hospital-acquired infection. J Hosp Infect 1988; 11 (Suppl A): 43-48
  • 17 Ponce-de-Leon S. The needs of developing countries and the resources required. J Hosp Infect 1991; 18 (Suppl A): 376-381
  • 18 Western KA, St John RK, Shearer LA. Hospital infection control--an international perspective. Infect Control 1982; 3 (06) 453-455
  • 19 Macías AE, Muñoz JM, Bruckner DA. et al. Parenteral infusions bacterial contamination in a multi-institutional survey in Mexico: considerations for nosocomial mortality. Am J Infect Control 1999; 27 (03) 285-290
  • 20 Rezende EM, Couto BR, Starling CE, Módena CM. Prevalence of nosocomial infections in general hospitals in Belo Horizonte. Infect Control Hosp Epidemiol 1998; 19 (11) 872-876
  • 21 Allpress AL, Rosenthal GL, Goodrich KM, Lupinetti FM, Zerr DM. Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J 2004; 23 (03) 231-234
  • 22 Linam WM, Margolis PA, Staat MA. et al. Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure. Infect Control Hosp Epidemiol 2009; 30 (02) 109-116
  • 23 Fawley J, Chelius TH, Arca MJ. Relationship between perioperative blood transfusion and surgical site infections in pediatric general and thoracic surgical patients. J Pediatr Surg 2018; 53 (06) 1105-1110
  • 24 Casanova JF, Herruzo R, Diez J. Risk factors for surgical site infection in children. Infect Control Hosp Epidemiol 2006; 27 (07) 709-715
  • 25 Levy O, Wynn JL. A prime time for trained immunity: innate immune memory in newborns and infants. Neonatology 2014; 105 (02) 136-141