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Published on: February 9, 2011
Pediatric wound infections: a prospective multicenter study
J R Horwitz1, W J Chwals, J J Doski
1University of Texas-Houston Medical School and Hermann Children's Hospital, USA.
Insights
Pediatric surgical wound infections occur in 4.4% of cases. Factors like contamination and operation duration, not patient health status, significantly increase infection risk in children.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
Background:
- Surgical wound infections (SWI) are a major cause of postoperative morbidity in children.
- Limited North American data exists on pediatric SWI incidence and risk factors.
Purpose of the Study:
- To prospectively determine the incidence of SWI in children across multiple institutions.
- To identify risk factors associated with SWI development in pediatric surgical patients.
Main Methods:
- Prospective follow-up of infants and children for 30 days post-operation.
- Data collected from pediatric surgical services at three institutions over 17 months.
Main Results:
- Overall SWI incidence was 4.4% in 846 patients.
- Significant risk factors for SWI included intraoperative contamination (p=0.006) and operation duration (p=0.03).
- No significant differences in SWI rates were found based on patient age, sex, ASA score, or preoperative status.
Conclusions:
- Pediatric SWI are primarily linked to intraoperative factors rather than patient's overall physiological condition.
- Performing procedures in the intensive care unit does not increase SWI incidence.
Objective:
Surgical wound infections remain a significant source of postoperative morbidity. This study was undertaken to determine prospectively the incidence of postoperative wound infections in children in a multi-institutional fashion and to identify the risk factors associated with the development of a wound infection in this population.
Summary Background Data:
Despite a large body of literature in adults, there have been only two reports from North America concerning postoperative wound infections in children.
Methods:
All infants and children undergoing operation on the pediatric surgical services of three institutions during a 17-month period were prospectively followed for 30 days after surgery for the development of a wound infection.
Results:
A total of 846 of 1021 patients were followed for 30 days. The overall incidence of wound infection was 4.4%. Factors found to be significantly associated with a postoperative wound infection were the amount of contamination at operation (p = 0.006) and the duration of the operation (p = 0.03). Comparing children who developed a wound infection with those who did not, there were no significant differences in age, sex, American Society of Anesthesiologists (ASA) preoperative assessment score, length of preoperative hospitalization, location of operation (intensive care unit vs. operating room), presence of a coexisting disease or remote infection, or the use of perioperative antibiotics.
Conclusions:
Our results suggest that wound infections in children are related more to the factors at operation than to the overall physiologic status. Procedures can be performed in the intensive care unit without any increase in the incidence of wound infection.
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