Risk Factors for Surgical Site Infection in Children

Objectives.To assess the appropriateness of using the indices developed by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) project to determine risk factors for surgical site infection (SSI) in children and, if not appropriate, to explore the factors related to SSI in children so these factors could be used in a risk index for pediatric patients.Design.Cohort study during more than 4 years.Setting.La Paz University Hospital, a national reference center that serves Health Area 5 of Madrid, Spain, which has approximately 500,000 inhabitants.Patients.Convenience sample consisting of the 3,646 children admitted for surgery who had a postsurgical stay of more than 2 days.Results.A model with 8 predictive factors (degree of surgical contamination; duration of surgery; type of surgery; use of a peripheral venous catheter, central venous catheter, or urinary catheter; number of diagnoses; and SSI exposition time) was created. Its relation to the SSI rate was better than that of the SENIC or NNIS indices. Its sensitivity, specificity, and area under the receiver–operating characteristic curve were higher than that of the SENIC index.Conclusions.The model that we created seems to be more adequate for predicting SSI and evaluating pediatric patients' intrinsic risk than the SENIC and NNIS indices.

Download Full-text

A prospective study of surgical site infection of orthopedic implant surgeries

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175651 ◽

2017 ◽

Vol 4 (1) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Muhammad Thahir ◽

Suresh Gandhi ◽

Kalaivanan Kanniyan ◽

Ravi Kumar

Keyword(s):

Risk Factors ◽

Prospective Study ◽

Surgical Site Infection ◽

Infection Rate ◽

Risk Index ◽

Univariate Analysis ◽

Cost Of Care ◽

Orthopaedic Implant ◽

Site Infection ◽

Duration Of Surgery

Background: Surgical-site infection accounts for approximately 10% of all hospital-acquired infections, which are estimated to double the cost of care and result in an additional mean of 6.5 days of hospital stay. We did prospective study of surgical site infection of orthopaedic implant surgeries.Methods: The aim of the study is to assess the clinical and microbiological outcome of 125 patients who had open reduction and internal fixation with implants and prosthesis at Southern Railway Hospital from January 2006 to January 2007, and its strength of association with major risk factors using univariate analysis. In our study, Patients were allocated in to three groups as NINS risk index group 0, 1 and 2 with risk factors as duration of surgery >2 hours and ASA class ≥3. Post-operative wound infection was diagnosed based on the criteria of Center of Disease Control and assessed for the period of 6 weeks using National Nosocomial Infections Surveillance Risk Index.Results: There were 87 male and 38 females in the study. From 125 Patients, 13 patients had post-operative superficial surgical site infection and presented within 21 days of operation. The infection rate was 10.4%. Two Patients developed deep infection after 6 weeks of study. All the cases with superficial infection were followed at regular intervals, 11 cases resolved with regular dressing and antibiotics but 2 cases continued to discharge sinus up to 3 months.Conclusions: The study showed that the risk of infection rate increased significantly with ASA score, duration of surgery, obesity and NINS risk index. There was no significant association of infection rate with age, diabetes and smoking.

Download Full-text

Incidence and risk factors for surgical site infection in general surgeries

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1502.2848 ◽

2017 ◽

Vol 25 (0) ◽

Cited By ~ 10

Author(s):

Rafael Lima Rodrigues de Carvalho ◽

Camila Cláudia Campos ◽

Lúcia Maciel de Castro Franco ◽

Adelaide De Mattia Rocha ◽

Flávia Falci Ercole

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Hospital Stay ◽

Risk Index ◽

Site Infection ◽

Duration Of Surgery ◽

Staphyloccocus Aureus ◽

Preoperative Hospital Stay ◽

Associated Risk Factors ◽

Clean Contaminated

ABSTRACT Objective: to estimate the incidence of surgical site infection in general surgeries at a large Brazilian hospital while identifying risk factors and prevalent microorganisms. Method: non-concurrent cohort study with 16,882 information of patients undergoing general surgery from 2008 to 2011. Data were analyzed by descriptive, bivariate and multivariate analysis. Results: the incidence of surgical site infection was 3.4%. The risk factors associated with surgical site infection were: length of preoperative hospital stay more than 24 hours; duration of surgery in hours; wound class clean-contaminated, contaminated and dirty/infected; and ASA index classified into ASA II, III and IV/V. Staphyloccocus aureus and Escherichia coli were identified. Conclusion: the incidence was lower than that found in the national studies on general surgeries. These risk factors corroborate those presented by the National Nosocomial Infection Surveillance System Risk Index, by the addition of the length of preoperative hospital stay. The identification of the actual incidence of surgical site infection in general surgeries and associated risk factors may support the actions of the health team in order to minimize the complications caused by surgical site infection.

Download Full-text

Risk Factors Associated with Surgical Site Infection in Pediatric Patients Undergoing Spinal Deformity Surgery

JBJS Reviews ◽

10.2106/jbjs.rvw.19.00163 ◽

2020 ◽

Vol 8 (3) ◽

pp. e0163

Author(s):

Hiroko Matsumoto ◽

Matthew E. Simhon ◽

Megan L. Campbell ◽

Michael G. Vitale ◽

Elaine L. Larson

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Spinal Deformity ◽

Pediatric Patients ◽

Site Infection ◽

Factors Associated ◽

Spinal Deformity Surgery

Download Full-text

Assessment of risk factors for surgical site infection following caesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194886 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4518

Author(s):

Aditi Sangwan ◽

Vani Malhotra

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Surgical Site Infection ◽

Site Infection ◽

Emergency Caesarean ◽

Group I ◽

Number Of Patients ◽

Duration Of Surgery ◽

Wound Discharge ◽

Group Ii

Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus. Mean duration of resuturing was 17.42±6.98 days. Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery.

Download Full-text

Surgical Site Infection Rates and Risk Factors in Orthopedic Pediatric Patients in Madrid, Spain

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0000000000000232 ◽

2014 ◽

Vol 33 (7) ◽

pp. 693-696 ◽

Cited By ~ 2

Author(s):

Almudena Quintás Viqueira ◽

Gil Rodríguez Caravaca ◽

José Antonio Quesada Rubio ◽

Victoria Soler Francés

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Pediatric Patients ◽

Site Infection ◽

Infection Rates

Download Full-text

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

BMC Infectious Diseases ◽

10.1186/s12879-020-05567-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xufei Zhang ◽

Zhiwei Wang ◽

Jun Chen ◽

Peige Wang ◽

Suming Luo ◽

...

Keyword(s):

Risk Factors ◽

Colorectal Surgery ◽

Surgical Site Infection ◽

Large Scale ◽

Risk Index ◽

Cross Sectional Study ◽

Site Infection ◽

Cross Sectional ◽

Medical Expenses ◽

Related Risk

Abstract Purposes Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors. Methods Two multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery. Results In total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088–3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926–7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200–0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187–0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group. Conclusion This study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China.

Download Full-text

Prevalence and risk factors for surgical site infection after colorectal surgery: a multiple-center prospective study of 3,663 consecutive patients in China

10.21203/rs.2.20226/v1 ◽

2020 ◽

Author(s):

Yu Zhang ◽

Hui-Quan Gan ◽

Jing-Fang Zhou ◽

Ya-Jie Gong ◽

Liu-Yi Li ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Colorectal Surgery ◽

Surgical Site Infection ◽

Prevalence Rate ◽

Demographic Data ◽

Risk Index ◽

Klebsiella Pneumonia ◽

Site Infection ◽

Extended Spectrum Beta Lactamase

Abstract Background: Surgical site infection (SSI) after colorectal surgery (CRS) remains a significant problem for its negative clinical outcomes. However, it is poorly understood in China . This study aims to investigate the prevalence, risk factors and microbiology of SSI after CRS. Methods: A nationwide prospective multicenter design was applied. Patients in 19 Chinese hospitals from 2015 to 2018 were prospectively monitored for SSI after CRS. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using univariate and multivariate logistic regression models. Results: Among 3,663 study participants, 134(3.66%) episodes of SSI were identified. The prevalence rate of SSI decreased from 5.9 infections per 100 procedures in 2014 to 3.1 infections per 100 procedures in 2017 (prevalence rate ratio [PRR], 0.52; 95% CI, 0.28–0.94). The SSI rates were 1.88, 4.15, 6.27 and 11.58 per 100 operations for the National Nosocomial Infections Surveillance system (NNIS) risk index categories of 0, 1, and 2 or 3, respectively. Escherichia coli (54/134, 40.3%) and Klebsiella pneumoniae (10/134, 7.5%) were the most frequently isolated microorganisms. A high prevalence of antibiotic resistance were observed in our study, with rates of extended spectrum beta-lactamase-producing or carbapenem-resistant Escherichia coli and Klebsiella pneumonia of 50.0%(27/54) and 30.0%(3/10) respectively. Preoperative hospital stay ≥ 48h (OR=2.28, 95% CI: 1.03–5.02) and contaminated or dirty wound (OR=3.38, 95% CI: 1.88–6.06) were significantly associated with increasing risk of SSI after CRS. Conclusion: A statistically significant but modest decrease in the prevalence rate of CRS SSI over the 4-year study period was observed in this study. Noticeably, the relatively high rates of multidrug-resistant pathogens causing SSI after CRS should be alert despite of the small number of isolates identified in our survey.

Download Full-text

Incidence, risk factors and Microorganisms for post caesarean Surgical Site Infection In A Tertiary Care Centre in Bangladesh

Journal of Dhaka Medical College ◽

10.3329/jdmc.v28i2.51148 ◽

2021 ◽

Vol 28 (2) ◽

pp. 136-141

Author(s):

Shahfinaz Mehzabin ◽

Mohmmad Mahbub Elahi ◽

Debashish Bar ◽

Banalata Sinha ◽

Tahmina Akter ◽

...

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Surgical Site Infection ◽

Surgical Site Infections ◽

Site Infection ◽

Medical College ◽

Related Risk ◽

Microbiological Methods ◽

Duration Of Surgery ◽

History Of

Background: Surgical site infection (SSI) is a common complication following caesarean section (C-section) and mainly responsible for increased maternal morbidity and higher treatment costs. This study will determine the incidence and risk factors of surgical site infections following caesarean section in Dhaka Medical College Hospital (DMCH). Materials and Methods: This is a retrospective observational study which was conducted among patients having post caesarean surgical site infections attending post-natal outdoor clinic of DMCH from January, 2019 to December, 2019. Data were collected in structured questionnaire. Culturebased microbiological methods were used to identify causal agents in postoperative wounds. Results: Overall SSI rate following caesarian section was 4.44%.Patient related risk factors were inadequate antenatal check-up, emergency procedures, malnutrition (22.44%), anaemia (21.46%) associated comorbidity (59.46%), history of rupture membrane >12 hours (40.98%) and had history of prolonged labour pain >12 hours (16.10%).Surgery related risk factors were repeated per vaginal examinations by untrained birth attendant (21.95%) & duration of surgery>1 hour (62.93%). The most common organisms responsible for SSI were Staphylococcus aureus 44(21.46%) and Escherichia coli 31(15.12%). The most sensitive antibiotics were aminoglycosides, cephalosporin & cloxacillin. Conclusion: Most of the risk factors for surgical site infection following caesarean section identified in this study can be modified through intervention. However the microorganisms detected from our patient showed a high degree of resistance for commonly prescribed antimicrobials in our set-up. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 136-141

Download Full-text

Risk Adjustment for Surgical Site Infection After Median Sternotomy in Children

Infection Control and Hospital Epidemiology ◽

10.1086/513123 ◽

2007 ◽

Vol 28 (4) ◽

pp. 398-405 ◽

Cited By ~ 11

Author(s):

Jessica Kagen ◽

Warren B. Bilker ◽

Ebbing Lautenbach ◽

Louis M. Bell ◽

Susan E. Coffin ◽

...

Keyword(s):

Surgical Site Infection ◽

Pediatric Patients ◽

Characteristic Curve ◽

Risk Index ◽

Tertiary Care ◽

Median Sternotomy ◽

Case Definition ◽

Site Infection ◽

Retrospective Case ◽

Risk Indices

Objective.To determine whether the National Nosocomial Infections Surveillance (NNIS) System risk index adequately stratified a population of pediatric patients undergoing cardiac surgery according to the risk of developing surgical site infection (SSI).Design.A retrospective, case-control study.Setting.An urban tertiary care children's hospital.Patients.Patients who had a median sternotomy performed between January 1,1995, and December 31, 2003, were eligible for inclusion in the study. For all case patients, medical records were reviewed to verify that all patients met the case definition for SSI. Control subjects were chosen randomly from among all patients who underwent median sternotomy during the study period who did not develop SSI.Results.Thirty-eight patients with SSI and 172 patients without SSI were included. One hundred six patients (50%) were male. The median patient age was 4 months. The sensitivity of the NNIS risk index with cutoff scores of 0 to 1 and 2 to 3 was 20%. The distribution of patients with SSI for an NNIS risk index score of 0 was 0%; for a score of 1, 80%; for a score of 2, 20%; and for a score of 3, 0%. The distribution of patients without SSI for a scores of 0 was 4%; for a score of 1, 87%; for a score of 2, 9%; and for a score of 3, 0%. The area under the receiver-operating characteristic curve (AUC) of the original NNIS risk index was 0.57. The modified risk indices did not perform significantly better, with an AUC range of 0.58 to 0.73.Conclusions.The NNIS risk index did not adequately stratify pediatric patients undergoing median sternotomy according to their risk of developing an SSI. Various modifications to the risk index yielded only slightly higher AUC values.

Download Full-text