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Published on: June 16, 2023
Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants
Linnéa Burman1, Maia Diaz1, Margrét Brands Viktorsdóttir1
1Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Pediatric Surgery, Lund, Sweden.
Insights
Infants undergoing laparoscopic-assisted gastrostomy (LAG) have a high rate of wound infections, often caused by common skin bacteria. No specific risk factors like age or gender were identified in this study.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Wound Care
Background:
- Laparoscopic-assisted gastrostomy (LAG) is a common pediatric surgical procedure.
- Wound infections after LAG are a growing concern, particularly with rising antibiotic resistance.
- Understanding infection rates and risk factors in infants is crucial for improving outcomes.
Purpose of the Study:
- To determine the frequency of wound infections following LAG in children under two years old.
- To identify potential risk factors associated with these infections.
- To characterize the bacterial species involved in LAG wound infections.
Main Methods:
- Retrospective chart review of 141 infants undergoing LAG between 2010 and 2017.
- Analysis of wound infection data, bacterial cultures, and antibiotic treatments within 30 days post-surgery.
- Multivariate logistic regression to identify independent risk factors for infection.
Main Results:
- A 27% rate of clinical wound infection was observed in infants after LAG.
- Commonly identified bacteria included *Staphylococcus aureus* and *Streptococcus pyogenes*, alongside respiratory and intestinal microbes.
- No independent risk factors such as age, gender, or prior diagnoses were found to be associated with infection.
Conclusions:
- Infants exhibit a high incidence of clinical wound infections post-LAG, even with standard antibiotic prophylaxis and wound care.
- The study did not identify specific demographic or clinical factors that independently predict wound infection risk in this population.
- Further research may be needed to explore novel prevention strategies for LAG-associated wound infections in infants.
Abstract:
Background Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved. Methods Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures. Results The 141 included infants underwent surgery at a median age of 10 months (range: 1-24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4-30). The most common microbes discovered were skin bacteria Staphylococcus aureus or Streptococcus pyogenes , but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis. Conclusion Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.
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