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Surgery-Associated Infections among Infants Born Extremely Preterm
Andi L Shane1, Nellie I Hansen2, Mohannad Moallem3
1Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
Insights
Surgery-associated infections (SAI) occurred in 7% of extremely premature infants. Gastrointestinal surgeries posed a higher risk for these invasive infections and death compared to central nervous system procedures.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Surgical Outcomes
Background:
- Surgery is common in extremely premature infants.
- Understanding the risks of surgery-associated infections (SAI) is crucial for this vulnerable population.
Purpose of the Study:
- To determine the incidence and characteristics of invasive infections following surgical procedures in extremely premature infants.
Main Methods:
- Prospective observational study of infants born between 22-28 weeks gestation.
- SAI defined as culture-confirmed bacteremia, fungemia, or meningitis within 14 days of surgery.
- Data collected from April 2011 to March 2015 across Neonatal Research Network centers.
Main Results:
- 18% of 6573 infants underwent surgery; 7% developed SAI.
- Gastrointestinal procedures (76%) were most common.
- Coagulase-negative staphylococci were the most frequent pathogen (40%).
- Risk of SAI or death was higher after gastrointestinal surgery (16%) versus CNS surgery (7%).
Conclusions:
- Invasive postoperative infections affect 7% of extremely premature infants undergoing surgery.
- Findings can guide empiric antimicrobial therapy and preventive strategies for postoperative care.
Objective:
To assess the burden of invasive infection following surgery (surgery-associated infections [SAI]) among infants born extremely premature.
Study Design:
This was an observational, prospective study of infants born at gestational age 22-28 weeks hospitalized for >3 days, between April 1, 2011, to March 31, 2015, in academic centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. SAI was defined by culture-confirmed bacteremia, fungemia, or meningitis ≤14 days following a surgical procedure.
Results:
Of 6573 infants, 1154 (18%) who underwent surgery were of lower gestational age (mean [SD]: 25.5 [1.6] vs 26.2 [1.6], P < .001), lower birth weight (803 [220] vs 886 [244], P < .001), and more likely to have a major birth defect (10% vs 3%, P < .001); 64% had 1 surgery (range 1-10 per infant). Most underwent gastrointestinal procedures (873, 76%) followed by central nervous system procedures (150, 13%). Eighty-five (7%) infants had 90 SAIs (78 bacteremia, 5 fungemia, 1 bacteremia and meningitis, 6 meningitis alone). Coagulase-negative staphylococci were isolated in 36 (40%) SAI and were isolated with another organism in 5 episodes. Risk of SAI or death ≤14 days after surgery was greater after gastrointestinal compared with central nervous system procedures (16% vs 7%, adjusted relative risk [95% CI]: 1.95 [1.15-3.29], P = .01). Death ≤14 days after surgery occurred in 141 of the 1154 infants; 128 deaths occurred after gastrointestinal surgeries.
Conclusions:
Surgical procedures were associated with bacteremia, fungemia, or meningitis in 7% of infants. The epidemiology of invasive postoperative infections as described in this report may inform the selection of empiric antimicrobial therapy and postoperative preventive care.
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