Surgical site infections in a longitudinal cohort of neonatal intensive care unit patients

Abstract

Objective To estimate the incidence and identify risk factors for surgical site infections (SSIs) among infants in the neonatal ICU (NICU). Study Design A prospective cohort study of infants undergoing surgical procedures May 2009–April 2012 in three NICUs was performed. SSI was identified if documented by an attending neonatologist and treated with intravenous (IV) antibiotics. Independent risk factors were identified using logistic regression, adjusting for NICU. Result A total of 902 infants underwent 1,346 procedures and experienced 60 SSIs (incidence: 4.46/100 surgeries). Risk factors for SSIs included younger chronologic age(OR 1.03/day decrease,95% CI 1.01,1.04), lower gestational age(OR 1.09/week decrease, CI 1.02,1.18), male sex(OR 1.18, CI1.04,1.34), and use of central venous catheter(OR 4.40, CI1.89,10.24). Only 43% had surgical site cultures obtained and Staphylococcus aureus was most commonly isolated. Conclusion SSIs complicated 4.46% of procedures performed in the NICU. Although few modifiable risk factors for SSIs were identified, future efforts should focus on evaluating the impact of current prevention strategies on the incidence of neonatal SSI.

Surgical Site Infection in a Tertiary Neonatal Surgery Centre

“…Our findings that prematurity and lower birth weights were not significant risk factors for SSI were consistent with the findings of Segal et al and Clements et al 10,12 However, the largest study to date of SSI in the neonatal population, analyzing 1346 procedures, identified lower gestational age as an independent risk factor for SSI. 11 Our study did not identify any association between chronological age at the time of surgery (<6 days vs. !6 days of age) and the risk of developing SSI. This is in contrast to Segal et al and Clements et al, which identified older age at the time of surgery as being associated with increased risk of SSI.…”

“…The incidence of SSI found in our neonatal population was similar to other published studies (4.3-14.9%). [9][10][11][12] It is noteworthy that the two studies, which identified much lower incidence of SSI (4.3% Segal et al and 4.5% Prasad et al), 10,11 had proportionally far fewer gastrointestinal procedures in their cohort (42% and 46%, respectively, compared with 72% in our population).…”

“…Segal et al had a 15% incidence SSI with primary closure of gastroschisis, compared with 7.1% with delayed closure. As conjectured by Prasad et al, 11 the infants with gastroschisis had a higher risk of SSI due to the exposed bowel and a contaminated abdominal wall defect after vaginal delivery. In contrast, evaluation of patients managed for gastroschisis in the Canadian Pediatric Surgery Network (CAPSNet) database showed a significantly higher rate of SSI in patients with delayed closure (>24 h) than immediate closure (<6 h).…”

“…This is consistent with the findings of similar studies. [9][10][11] Shankar et al reports a median length of stay of 14.5 days in the SSI group compared with 8 days in babies without SSI. The increase of 6 days length of stay between the groups increased the risk of SSI by 1.4 times.…”

Effects of intraoperative temperatures on postoperative infections in infants and neonates

“…The association between intraoperative or immediate postoperative hyperthermia and SSI held even when controlling for wound class and ASA on multivariable analysis. Hyperthermia may be because of existing infection at the time of surgery, a factor that has been shown to increase risk of SSI in neonates [22]. In our patient population, we examined those with existing infections more closely.…”