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Wound infections in pediatric surgery: a study of 575 patients in a university hospital
E O Duque-Estrada1, M R Duarte, D M Rodrigues
1Hospital das Clínicas de Teresópolis, Av. Alberto Torres, s/n, Teresópolis, Rio de Janeiro, Brazil, 25950-000. duque@cremerj.com.br
Insights
Pediatric surgical wound infections (WI) occurred in 6.7% of cases. Factors during surgery, like operation duration and contamination, significantly increased WI risk in children, not patient status.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Hospital-Acquired Infections
Background:
- Surgical wound infections (WI) are a major cause of postoperative illness in children.
- Limited data exists on pediatric surgical wound infection rates compared to adults.
Purpose of the Study:
- To determine the incidence of postoperative WIs in pediatric patients at a university hospital.
- To compare pediatric surgical WI rates with international reports.
- To identify risk factors associated with WIs in pediatric surgical patients.
Main Methods:
- Retrospective epidemiologic study of 537 infants and children undergoing 575 operations over 7 years.
- Analysis of wound infection rates based on wound classification (clean, clean-contaminated, contaminated, dirty/infected).
- Statistical comparison of patient factors and operative variables between infected and non-infected groups.
Main Results:
- Overall WI incidence was 6.7% (39 cases).
- Infection rates increased with wound contamination and operation duration (P < 0.001).
- Presence of a resident or intern during surgery was associated with higher infection rates (P < 0.001).
Conclusions:
- Pediatric surgical wound infections are influenced more by intraoperative factors than patient's overall physiological status.
- Factors like operation duration, contamination, and surgical team composition are key targets for infection control strategies.
- Findings provide baseline data for developing targeted interventions to reduce WI risk in pediatric surgery.
Abstract:
Surgical wound infections (WI) remain a significant source of postoperative morbidity. This epidemiologic study was undertaken to determine retrospectively the incidence of postoperative WI in children in a university hospital and include critical comparisons of pediatric surgery WI rates between different international reports. As few data exist on postoperative WIs in pediatric patients, in contrast to numerous reports in adults, all infants and children undergoing operations in the pediatric surgical service in our institution during a 7-year period were reviewed for development of a WI, a total of 537 patients who underwent 575 operations. WIs occurred in 39 cases (6.7%). Clean wounds (56.8% of patients) had an infection rate of 2.7%, clean-contaminated (23.1%) 10.5%, contaminated (12.9%) 13.5%, and dirty/infected (7.2%) 14.6%. Increasing duration of operation ( P < 0.001), contamination at operation ( P < 0.001), and a new element in the operation - a resident or intern - ( P < 0.001) were all associated with a higher incidence of infection, despite efforts at infection-control practices including improved sterilization methods and barriers, surgical technique, and availability of antimicrobial prophylaxis. The total incidence of wound infection in this population was comparable to that in other reports. Comparing children who developed a wound infection with those who did not, there were no significant differences in age, sex, American Society of Anesthesiologists preoperative assessment score, length of preoperative hospitalization, location of operation (intensive care unit vs operating room), the presence of a coexisting disease or remote infection, or the use of perioperative antibiotics. These baseline data may aid in forming strategies to lower the risk of WI in children. Our results suggest that WIs in children are related more to factors at operation than to the patients overall physiologic status.
