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[Importance of infection following laparotomy in childhood]
Insights
Postoperative sepsis is a significant risk in pediatric laparotomy patients, especially infants and those with abdominal wall defects or intestinal issues. High mortality rates are linked to premature birth and specific bacterial infections.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Microbiology
Context:
- A retrospective study analyzed 579 pediatric laparotomy cases (excluding appendicitis and hernias) at a single center between 1975-1982.
- Postoperative sepsis incidence was 12.8%, with higher rates in infants under one year old.
Purpose:
- To investigate the incidence, risk factors, causative pathogens, and outcomes of postoperative sepsis in children undergoing laparotomy.
- To identify specific pediatric surgical conditions associated with increased sepsis risk and mortality.
Summary:
- 74 patients (12.8%) developed postoperative sepsis, with 51 showing positive bacteriological findings, predominantly Gram-negative enterogenous pathogens.
- Infants, particularly those with abdominal wall defects, intestinal atresia, or perforation, faced significantly higher sepsis morbidity.
- Relaparotomies and specific infections (e.g., Candida albicans, polymicrobial) increased sepsis-related mortality.
Impact:
- Identifies critical patient groups and surgical conditions requiring enhanced sepsis surveillance and prevention strategies in pediatric surgery.
- Highlights the importance of microbiological diagnostics in guiding treatment and improving outcomes for pediatric surgical sepsis.
- Informs clinical practice regarding the management of sepsis in neonates and infants with congenital gastrointestinal anomalies.
Abstract:
Laparotomy was performed on 579 children at the University Clinic of Paediatric Surgery in Mainz from 1.1.1975 to 31.12.1982. The children were up to 15 years of age; appendicitis or inguinal and umbilical hernia cases were not included. Postoperative sepsis occurred in 74 patients (12.8% of all children with laparotomy); in 51 cases positive bacteriological findings were seen besides the clinical and clinicochemical ones. Sepsis morbidity was particularly high in children who had not yet completed their first year of life (postoperative sepsis occurring in approximately every fourth infant); among the disease patterns, the following were particularly prominent: Defects of the abdominal wall (23 out of 50 children developed postoperative sepsis); intestinal atresia (18 out of 59 children); intestinal perforation (11 out of 39 children). In addition, sepsis morbidity was enhanced after relaparotomies. Gram-negative bacteria were most frequent among the 51 patients with bacteriologically positive findings; these bacteria consisted mostly of representatives of the group of enterogenous pathogens. These groups of bacteria were also the most frequently occurring pathogens in mixed and secondary infections. 33 out of 74 children with postoperative sepsis died. The mortality rate was 68% in prematurely born infants compared with mature newborns. Lethality was highest among children with congenital defects of the abdominal wall and intestinal perforations. Among the patients with bacteriologically positive findings the lethality was particularly high with multiple attacks of sepsis, in case of septitides caused by multiple pathogens, by Candida albicans and after relaparotomy.