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[Wound infection in pediatric surgery]
Insights
Pediatric surgical wound infection rates between 1977-1982 were 3.37%. Infections in clean wounds stemmed from external Staphylococci, while others originated from patient enteric flora, guiding antibiotic strategies.
Area of Science:
- Infectious Disease
- Surgical Site Infections
- Pediatric Surgery
Context:
- Analysis of pediatric surgical wound infections over a five-year period (1977-1982).
- Comparison of infection rates across different wound classifications (clean, clean-contaminated, contaminated, dirty).
- Benchmarking against adult surgical site infection rates.
Purpose:
- To determine the incidence and sources of pediatric surgical wound infections.
- To identify bacterial pathogens responsible for different wound types.
- To inform and guide empirical antibiotic policies in pediatric surgical care.
Summary:
- Overall pediatric surgical wound infection rate was 3.37% (97/2898).
- Infection rates varied significantly by wound class: clean (1.07%), clean-contaminated (3.8%), contaminated (15.4%), and dirty (21.8%).
- Bacteriological analysis indicated exogenous Staphylococci for clean wounds and endogenous enteric flora (E. coli, B. fragilis) for others.
Impact:
- Findings support targeted antibiotic prophylaxis based on wound classification and likely microbial sources.
- Highlights the importance of infection prevention to reduce patient discomfort and healthcare costs.
- Lower infection rates in pediatric patients compared to adults suggest potential differences in host factors or surgical practices.
Abstract:
During the five-year period 1977-1982, 97 (3,37%) out of 2,898 pediatric surgical wounds became infected, 23 out of 2,140 (1,07%) corresponded to "clean" wounds, 18/475 (3,8%) belonged to the "clean-contaminated", 14/91 (15,4%) to the "contaminated" and 42/192 (21,8%) to the "dirty" groups. These rates were somewhat lower than those found in similar studies carried out in adults. The bacteriologic studies revealed that the source of infection of "clean" wounds was exogenous and almost exclusively due to --Staphylococci, whereas that of most of the remaining wounds was the patient's own enteric flora, with aerobic and anaerobic bacteria and very constant presence of E. coli and B. fragilis. Our antibiotic policies were guided by this evidence. In spite of the lack of mortality related to this minor complication, the risk and uncomfort incurred by the patients aside with the higher cost of hospital stay justify every effort to prevent this complication.