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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2005, Number 3

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Rev Invest Clin 2005; 57 (3)

Risk factors for surgical site infections in newborns in a neonatal intensive care unit

García HJ, Rodríguez-Medina X, Franco-Gutiérrez M, Miranda-Novales G, Villegas-Silva R

Language: Spanish
References: 28
Page: 425-433
PDF size: 70.84 Kb.


ABSTRACT

Objective. To identify risk factors associated to surgical site infection (SSI) in newborns. Design. Case-control study. Site. Neonatal intensive care unit (NICU), Hospital de Pediatría, Centro Médico Nacional SXXI, IMSS. Patients. 279 patients were included (125 cases and 154 controls). Data. Gestational age, birth weight, previous infection, hospital stay, type of surgery, surgical drains, length of surgical procedure, bleeding during surgery, surgical site classification, serum albumin, classification of infection and surgeon performing the procedure. Results. Five independent factors associated to SSI were identified: surgical reinterventions (OR = 13.6, CI 95% = 4.3-42.7); length of surgery ‹ 60 minutes (OR = 3.0, CI 95% = 1.4-6.3); preoperative stay ‹ 5 days (OR = 2.8, CI 95% = 1.3-5.6); consultant surgeon (OR = 2.7, CI 95% = 1.3-5.3), and previous systemic infection (OR = 2.1, CI 95% = 1.1-4.3). Lethality was 8.2% (n = 23), 74% in the group of cases (n = 17). Conclusions. Factors associated to SSI are mainly related to the characteristics of surgery and those of the patient. Lethality was low, but most of deaths were in the group of cases.


REFERENCES

  1. Centers for disease control and prevention, Hospital and control infection practices advisory committee. Guideline for prevention of surgical site infection (SSI). Am J Infect Control 1999; 27: 250-78.

  2. Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993; 6: 428-42.

  3. Porras JD, Vilar D, Cashat D, Avila C. Principios de profilaxis antimicrobiana en cirugía pediátrica. Bol Med Hosp Infant Méx 1999; 56: 340-52.

  4. Kawagoe JY, Segre CAM, Pereira CR, Cardoso MF, Silva CV, Fukushima JT. Risk factors for nosocomial infections in critically ill newborns: A 5-year prospective cohort study. Am J Infect Control 2001; 29: 109-14.

  5. Fariñas AC, Fariñas MC, Fernández MC, Llorca J, Casanova D, Delgado RM. Analysis of risk factors for nosocomial sepsis in surgical patients. Br J Surg 2000; 87: 1076-81.

  6. Garibaldi RA, Cushing D, Lerer T. Risk factors postoperative infection. Am J Surg 1991; 91(Suppl. 3B): 158S-163S.

  7. Nichols RL. Surgical wound infection. Am J Med 1991; 91(Suppl 3B): 54S-64S.

  8. Fonkalsrud K. Infections and inmunologic disorders in pediatric surgery. Philadelphia: W.B. Saunders; 1993, p. 169-83.

  9. Davenport M, Doing CM. Wound infection in pediatric surgery: a study in 1,094 neonates. J Pediatr Surg 1993; 26-30.

  10. Quintero GA, Nieto JA, Lerma CH. Infección en cirugía. Bogotá: Panamericana; 2001, p. 12-39.

  11. Zaidi M, Ponce de León S, Flores J, Moncada D. Infecciones nosocomiales en una Unidad de Pediatría. Bol Med. Hosp Infant Méx 1988; 45: 415-23.

  12. Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med 1991; 91(Suppl. 3B): 72S-75S.

  13. Porras G, Hernández MH, Porras JD, García AB. Respuesta endocrino metabólica neonatal a la cirugía. Bol Med Hosp Infant Méx 1994; 51: 804-10.

  14. Madden NP, Levinsky RJ, Bayston R, Harvey B, Turner MW, Spitz L. Surgery, sepsis, and nonspecific immune function in neonates. J Pediatr Surg 1989; 24: 562-6.

  15. Fleiss. Statistical Methods for rates and proportions. 2nd Ed. Wiley; 1981, p. 38-45.

  16. Hosmer DW Jr, Lemeshow S. Applied logistic regression. New York: Wiley; 1989: 82-106.

  17. Bhattacharyya N, Kosloke A. Postoperative wound infection in pediatric surgical patients: a study of 676 infants and children. J Pediatr Surg 1990; 25: 125-9.

  18. Grohskopf LA, Sinkowitz CR, Garrett DO, Sohn AH, Levine GL, Siegel JD y cols. A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. J Pediatr 2002; 140: 432-8.

  19. Nagachinta T, Stephens M, Reitz B, Polk BF. Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis 1987; 156: 967-73.

  20. Khoene PS, Bein G. Patent ductus arteriosus in very low birth weight infants: complications of pharmacological and surgical treatment. J Perinatal Med 2001; 29: 327-34.

  21. Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori G, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991; 91(Suppl. 3B): 152S-157S.

  22. American Society of Health-System Pharmacists, Inc. ASHP Therapeutic Guidelines on Antimicrobial prophylaxis in surgery. 1999; 56: 1839-88.

  23. Smith TA, Dillon DM, Kotula RJ, Mutnick AH. Evaluation of antimicrobial surgical prophylaxis with multiattribute utility theory. Am J Health Syst Pharm 2001; 58: 251-5.

  24. Committee on Infectious Diseases, Committee on Drugs, and Section on Surgery of American Academy of Pediatrics. Antimicrobial prophylaxis in pediatric surgical patients. Pediatrics 1984; 74: 437-9.

  25. Martin C. Antimicrobial prophylaxis in surgery: general concepts and clinical guidelines. Infect Control Hosp Epidemiol 1994; 15: 463-71.

  26. Classen DC, Evans SR, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound Infection. N Engl J Med 1992; 326: 281-6.

  27. Korinek AM. Risk Factors for neurosurgical site infections after craniotomya: a prospective multicenter study of 2944 patients. Neurosurgery 1997; 41: 1073-81.

  28. Kelley Rl, Ring JC, Leggiadro RJ. Prophylaxis antibiotic use in pediatric cardiovascular surgery: a survey of current practice. Pediatr Infect Dis J 1995; 14: 267-69.




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