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Surgical infections in children
1Ohio State University College of Medicine, Columbus.
Insights
Pediatric surgical infections are a significant cause of mortality. Advances in understanding sepsis and new terminology are crucial for managing these complex infections in children.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Infection is a leading cause of mortality and complications in pediatric surgery.
- Impaired host resistance in children (e.g., due to prematurity, chemotherapy, or AIDS) increases susceptibility to opportunistic infections.
Purpose of the Study:
- To review recent advances in five key areas of pediatric surgical infections: sepsis, soft-tissue/wound, chest, abdominal, and miscellaneous/nosocomial infections.
- To highlight new concepts in sepsis, including its stages and inflammatory mediator interactions.
Main Methods:
- Review of recent literature, primarily retrospective observational studies.
- Focus on advancements in understanding sepsis, systemic inflammatory response syndrome, and multiorgan dysfunction syndrome.
Main Results:
- New terminology clarifies sepsis stages and inflammatory processes.
- Systemic inflammatory response syndrome can progress to multiorgan dysfunction syndrome, independent of the initial infection.
Conclusions:
- Understanding sepsis progression is critical for pediatric surgical patients.
- There is a significant need for prospective, randomized trials to guide optimal management and prevention strategies for pediatric surgical infections.
Abstract:
Infection remains a major cause of death and complication in pediatric surgery today. Impaired host resistance from such circumstances as immaturity, cancer chemotherapy, or AIDS predisposes to opportunistic infection by fungi, viruses, mycobacteria, and even protozoa. This review considers recent advances in five areas: 1) sepsis, 2) soft-tissue and wound infections, 3) chest infections, 4) abdominal infections, and 5) miscellaneous (including nosocomial) infections. Of particular importance are the new concepts of sepsis. The new terminology distinguishes stages in the septic process and a complex interaction of inflammatory mediators. The systemic inflammatory response syndrome may progress independently of the original infection to multiorgan dysfunction syndrome, and death. The reports cited herein are, for the most part, retrospective observational studies. There is a great need for prospective, randomized trials to answer questions about the optimal management of, and prevention of, pediatric surgical infections.