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Simon A, Meier CM, Baltaci Y, Müller R, Heidtmann SA, Zemlin M, Renk H. [Update Perioperative Antibiotic Prophylaxis in Neonatology]. Z Geburtshilfe Neonatol 2023; 227:421-428. [PMID: 37579789 DOI: 10.1055/a-2125-1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
This narrative review discusses basic principles of the perioperative antibiotic prophylaxis (PAP) in premature and at term newborns and refers to some particularities concerning the indication and dosing issues. Although this is a vulnerable patient population, the spectrum of activity should not be unnecessarily broad and the regular PAP must not be prolonged beyond 24 hours.
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Affiliation(s)
- Arne Simon
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum Homburg, Homburg, Germany
| | - Clemens Magnus Meier
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Homburg, Homburg, Germany
| | - Yeliz Baltaci
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum Homburg, Homburg, Germany
| | - Rachel Müller
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum Homburg, Homburg, Germany
| | | | - Michael Zemlin
- Klinik für Allgemeine Pädiatrie und Neonatologie, Universität des Saarlandes, Saarbrücken, Germany
| | - Hanna Renk
- Institut für Medizinische Mikrobiologie und Hygiene, Universitäts-Kinderklinik Tübingen, Tübingen, Germany
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2
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Li LT, Hebballi NB, Nguyen T, Morice C, Lally KP. Complication rates in very low and extremely low birth weight infants following laparotomy: a prospective study. Pediatr Surg Int 2023; 39:237. [PMID: 37477761 DOI: 10.1007/s00383-023-05520-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Surgical site occurrences (SSO), including surgical site infection, dehiscence, and incisional hernia, are complications following laparotomy. SSO rates in premature neonates are poorly understood. We hypothesize that SSO rates are higher among extremely low birth weight (ELBW) infants compared to very low birth weight (VLBW) infants and strive to determine the optimal abdominal closure method for these infants. METHODS We conducted a prospective observational study of infants < 1.5 kg (kg) undergoing laparotomy at two institutions from 1/1/2020 to 5/1/2022. Patients were grouped by weight and closure; SSO rates were computed and the association tested using Fisher's exact test. RESULTS We identified 59 patients and 104 total operations. At initial surgery, 37 patients weighed < 1 kg (ELBW); 22 patients weighed 1-1.5 kg (VLBW). Complication rate for ELBW was 6(16%) vs. 2(9%) in VLBW, but not significant (p = 0.45). More complications followed a single-layer compared to a two-layer closure (18 vs. 2), but not significant (p = 0.30). CONCLUSIONS SSO rates are higher for ELBW infants undergoing laparotomy, and fewer complications follow two-layer closure. However, these findings did not reach statistical significance. Further studies are needed to identify modifiable factors to reduce postoperative complications in these infants.
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Affiliation(s)
- Linda T Li
- Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Nutan B Hebballi
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, 6431 Fannin St., Houston, TX, 77030, USA
| | - Thian Nguyen
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, 6431 Fannin St., Houston, TX, 77030, USA
| | - Christina Morice
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, 6431 Fannin St., Houston, TX, 77030, USA
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, 6431 Fannin St., Houston, TX, 77030, USA
- Children's Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, 77030, USA
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Brachio SS, Gu W, Saiman L. Next Steps for Health Care-Associated Infections in the Neonatal Intensive Care Unit. Clin Perinatol 2023; 50:381-397. [PMID: 37201987 DOI: 10.1016/j.clp.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We discuss the burden of health care-associated infections (HAIs) in the neonatal ICU and the role of quality improvement (QI) in infection prevention and control. We examine specific QI opportunities and approaches to prevent HAIs caused by Staphylococcus aureus , multidrug-resistant gram-negative pathogens, Candida species, and respiratory viruses, and to prevent central line-associated bloodstream infections (CLABSIs) and surgical site infections. We explore the emerging recognition that many hospital-onset bacteremia episodes are not CLABSIs. Finally, we describe the core tenets of QI, including engagement with multidisciplinary teams and families, data transparency, accountability, and the impact of larger collaborative efforts to reduce HAIs.
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Affiliation(s)
- Sandhya S Brachio
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA.
| | - Wendi Gu
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA
| | - Lisa Saiman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH1-470, New York, NY 10032, USA; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
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Carr S, Gogal C, Afshar K, Ting J, Skarsgard E. Optimizing skin antisepsis for neonatal surgery: A quality improvement initiative. J Pediatr Surg 2022; 57:1235-1241. [PMID: 35397873 DOI: 10.1016/j.jpedsurg.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Surgical site infections (SSIs) are a significant determinant of morbidity in the Neonatal Intensive Care Unit (NICU). Chlorhexidine gluconate/isopropyl alcohol (CHG-IPA) skin prep has demonstrated superiority over Povidone-Iodine (PI) in preventing SSIs in adults, however FDA labeling discourages CHG use in infants <2 months. This project aimed to i) create evidence for safe CHG skin antisepsis in neonates; and ii) evaluate the safety and effectiveness of CHG skin prep for neonatal surgery. METHODS A literature review was conducted to assess the safety and effectiveness of neonatal CHG skin antisepsis. Following stakeholder engagement, a CHG surgical skin prep protocol and validated neonatal skin integrity tool to assess prep-associated skin injury were implemented in 50 consecutive, eligible neonates ≥1500 g and ≥34 weeks post conceptual age undergoing abdominal or thoracic surgery. SSI rates were compared to a matched, historical PI skin prep cohort. RESULTS 2%CHG-70%IPA or 0.5%CHG-70%IPA were used based on gestational age cutoffs. None of the CHG patients experienced adverse skin prep outcomes while 8% developed SSIs, compared to 14% in the historical PI cohort. CONCLUSION This project engaged NICU stakeholders in quality improvement work and informed the implementation of a safe and effective CHG skin prep protocol for neonatal surgery. LOE: IV.
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Affiliation(s)
- Sophie Carr
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carmina Gogal
- Clinical Care Analyst, Surgical Services and National Surgical Quality Improvement Program, BC Children's Hospital, Vancouver, Canada
| | - Kourosh Afshar
- Department of Surgery, British Columbia Children's Hospital/Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Joseph Ting
- Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Erik Skarsgard
- Department of Surgery, British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada.
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Meoli A, Ciavola L, Rahman S, Masetti M, Toschetti T, Morini R, Dal Canto G, Auriti C, Caminiti C, Castagnola E, Conti G, Donà D, Galli L, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Petrosillo N, Simonini A, Venturini E, Caramelli F, Gargiulo GD, Sesenna E, Sgarzani R, Vicini C, Zucchelli M, Mosca F, Staiano A, Principi N, Esposito S. Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention. Antibiotics (Basel) 2022; 11:antibiotics11070863. [PMID: 35884117 PMCID: PMC9311619 DOI: 10.3390/antibiotics11070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse.
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Affiliation(s)
- Aniello Meoli
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Lorenzo Ciavola
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Sofia Rahman
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Marco Masetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Tommaso Toschetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Riccardo Morini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Giulia Dal Canto
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Cinzia Auriti
- Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Luisa Galli
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Nicola Petrosillo
- Infection Prevention and Control—Infectious Disease Service, Foundation University Hospital Campus Bio-Medico, 00128 Rome, Italy;
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Gaetano Domenico Gargiulo
- Department of Cardio-Thoracic and Vascular Medicine, Adult Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
| | - Mino Zucchelli
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40138 Bologna, Italy;
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | | | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
- Correspondence: ; Tel.: +39-0521-903524
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Abdelgawad MA, Parambi DGT, Ghoneim MM, Alotaibi NH, Alzarea AI, Alanazi AS, Hassan A, Tony SM, Abdelrahim ME. A meta-analysis showing the effect of surgical site wound infections and associated risk factors in neonatal surgeries. Int Wound J 2022; 19:2092-2100. [PMID: 35445789 DOI: 10.1111/iwj.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022] Open
Abstract
A meta-analysis was performed to assess the effect of surgical site wound infections and risk factors in neonates undergoing surgery. A systematic literature search up to January 2022 incorporated 17 trials involving 645 neonates who underwent surgery at the beginning of the trial; 198 of them had surgical site wound infections, and 447 were control for neonates. The statistical tools like the dichotomous or continuous method used within a random or fixed-influence model to establish the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the risk factors and influence of surgical site wound infections in neonates undergoing surgery. Surgical site wound infections had significantly higher mortality with OR value 2.03 at 95% CI 1.40-2.95 with P-value <0.001, the longer length of hospital stay (MD, 31.88; 95% CI, 18.17-45.59, P < 0.001), and lower birthweight of neonates (MD, -0.30; 95% CI, -0.53 to -0.07, P = 0.01) compared with neonates with no surgical site wound infections undergoing surgery. However, no remarkable change was observed with surgical site wound infections in the gestational age at birth of neonates (MD, -0.70; 95% CI, -1.46 to 0.05, P = 0.07), and the preoperative antibiotic prophylaxis (OR, 1.28; 95% CI, 0.57-2.87, P = 0.55) compared with no surgical site wound infections for neonates undergoing surgery. Surgical site wound infections had significantly higher mortality, a longer length of hospital stay, and lower birthweight of neonates. However, they had no statistically significant difference in the gestational age at birth of neonates and the preoperative antibiotic prophylaxis compared with no surgical site wound infections for neonates undergoing surgery. Furthermore, evidence is needed to confirm the outcomes.
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Affiliation(s)
- Mohamed A Abdelgawad
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Della G T Parambi
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Mohammed M Ghoneim
- Department of Pharmacy Practice, Faculty of Pharmacy, AlMaarefa University, Ad Diriyah, Saudi Arabia
| | - Nasser Hadal Alotaibi
- Department of clinical pharmacy, College of pharmacy, Jouf university Sakaka, Al Jouf, Saudi Arabia
| | | | - Abdullah S Alanazi
- Department of clinical pharmacy, College of pharmacy, Jouf university Sakaka, Al Jouf, Saudi Arabia.,Health sciences research unit, Jouf university, Sakaka, Saudi Arabia
| | - Ahmed Hassan
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Sadat City (USC), Sadat City, Egypt
| | - Sara M Tony
- Clinical pharmacy department, Beni-suef specialized hospital, Beni-Suef, Egypt
| | - Mohamed Ea Abdelrahim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef, Beni-Suef University, Beni-Suef, Egypt
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Factors associated with neonatal surgical site infection after abdominal surgery. Pediatr Surg Int 2022; 38:317-323. [PMID: 34981147 DOI: 10.1007/s00383-021-05051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the risk factors for surgical site infections (SSIs) post-abdominal surgery in neonates. METHODS A retrospective, single-center cohort study was conducted using patient data from 2009 to 2018. Patient characteristics and several variables were analyzed to identify independent risk factors for SSI. RESULTS SSI occurred in 39/406 procedures (9.6%). Univariate analysis showed that the incidence of SSI was significantly higher in patients who had undergone multiple surgical procedures (P = 0.032), prolonged operations (P = 0.016), long-term hospitalization (P < 0.001), long-term antibiotic administration (P < 0.001), with methicillin-resistant Staphylococcus aureus (MRSA) colonization (P = 0.044), contaminated/dirty wounds (P < 0.001), and American Society of Anesthesiologists physical status of 3 or 4 (P = 0.021). Multivariate analysis identified prolonged operations [odds ratio (OR): 2.91 (1.21-8.01)] and contaminated/dirty wounds [OR: 5.42 (2.41-12.1)] as independent risk factors. Patients with SSI had a higher incidence of MRSA colonization (27.8% vs. 14.8%, P = 0.044), longer antibiotic administration (24 days vs. 8 days, P = 0.049), and longer hospitalization times (98 days vs. 43 days, P = 0.007) than those without SSIs. CONCLUSIONS Long operations exceeding 100 min and surgical procedures with contaminated/dirty wounds are independent risk factors for neonatal SSIs after abdominal surgery. SSIs were related to MRSA colonization during hospitalization, long-term antibiotic administration, and long-term hospitalization.
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Shane AL, Hansen NI, Moallem M, Wyckoff MH, Sánchez PJ, Stoll BJ. Surgery-Associated Infections among Infants Born Extremely Preterm. J Pediatr 2022; 240:58-65.e6. [PMID: 34461060 PMCID: PMC8712381 DOI: 10.1016/j.jpeds.2021.08.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/18/2021] [Accepted: 08/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the burden of invasive infection following surgery (surgery-associated infections [SAI]) among infants born extremely premature. STUDY DESIGN This was an observational, prospective study of infants born at gestational age 22-28 weeks hospitalized for >3 days, between April 1, 2011, to March 31, 2015, in academic centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. SAI was defined by culture-confirmed bacteremia, fungemia, or meningitis ≤14 days following a surgical procedure. RESULTS Of 6573 infants, 1154 (18%) who underwent surgery were of lower gestational age (mean [SD]: 25.5 [1.6] vs 26.2 [1.6], P < .001), lower birth weight (803 [220] vs 886 [244], P < .001), and more likely to have a major birth defect (10% vs 3%, P < .001); 64% had 1 surgery (range 1-10 per infant). Most underwent gastrointestinal procedures (873, 76%) followed by central nervous system procedures (150, 13%). Eighty-five (7%) infants had 90 SAIs (78 bacteremia, 5 fungemia, 1 bacteremia and meningitis, 6 meningitis alone). Coagulase-negative staphylococci were isolated in 36 (40%) SAI and were isolated with another organism in 5 episodes. Risk of SAI or death ≤14 days after surgery was greater after gastrointestinal compared with central nervous system procedures (16% vs 7%, adjusted relative risk [95% CI]: 1.95 [1.15-3.29], P = .01). Death ≤14 days after surgery occurred in 141 of the 1154 infants; 128 deaths occurred after gastrointestinal surgeries. CONCLUSIONS Surgical procedures were associated with bacteremia, fungemia, or meningitis in 7% of infants. The epidemiology of invasive postoperative infections as described in this report may inform the selection of empiric antimicrobial therapy and postoperative preventive care.
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Affiliation(s)
- Andi L Shane
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
| | - Nellie I Hansen
- Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, United States
| | - Mohannad Moallem
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Myra H. Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, United States
| | - Pablo J Sánchez
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Barbara J Stoll
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, GA, United States,Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
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Expanding antimicrobial stewardship strategies for the NICU: Management of surgical site infections, perioperative prophylaxis, and culture negative sepsis. Semin Perinatol 2020; 44:151327. [PMID: 33160696 DOI: 10.1016/j.semperi.2020.151327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review antibiotic stewardship strategies for neonatal intensive care units (NICU) in the areas of management of surgical site infections, perioperative prophylaxis and culture negative late onset sepsis. FINDING Review of local microbiology, stratification of surgical procedures by risk of contamination of the surgical site, and adherence to evidence-based principles of perioperative antibiotic administration (targeted therapy, effective dosing, appropriate timing and limiting duration post-operatively) can help to minimize unnecessary antibiotic use for neonatal surgery. Creating a late onset sepsis case definition, appropriate collection and interpretation of blood cultures, and instituting antibiotic time-outs can minimize the overuse of antibiotics for culture negative sepsis. CONCLUSION Effective implementation of these antimicrobial stewardship strategies in the NICU can reduce unnecessary antimicrobial use and limit the emergence of resistant pathogens.
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Rub DM, Dhudasia MB, Healy T, Mukhopadhyay S. Role of microbiological tests and biomarkers in antibiotic stewardship. Semin Perinatol 2020; 44:151328. [PMID: 33158600 DOI: 10.1016/j.semperi.2020.151328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Laboratory tests are critical in the detection and timely treatment of infection. Two categories of tests are commonly used in neonatal sepsis management: those that identify the pathogen and those that detect host response to a potential pathogen. Decision-making around antibiotic choice is related to the performance of tests that directly identify pathogens. Advances in these tests hold the key to progress in antibiotic stewardship. Tests measuring host response, on the other hand, are an indirect marker of potential infection. While an important measure of the patient's clinical state, in the absence of pathogen detection these tests cannot confirm the appropriateness of antibiotic selection. The overall impact these tests then have on antibiotic utilization depends the test's specificity for bacterial infection, clinical scenario where it is being used and the decision-rule it is being integrated into for use. In this review we discuss common and emerging laboratory tests available for assisting management of neonatal infection and specifically focus on the role they play in optimizing antibiotic utilization.
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Affiliation(s)
- David M Rub
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Miren B Dhudasia
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tracy Healy
- Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA, USA
| | - Sagori Mukhopadhyay
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Walker S, Amin R, Arca MJ, Datta A. Effects of intraoperative temperatures on postoperative infections in infants and neonates. J Pediatr Surg 2020; 55:80-85. [PMID: 31708210 DOI: 10.1016/j.jpedsurg.2019.09.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Perioperative hypothermia has been shown to increase surgical site infection (SSI) rates in adults. We sought to characterize whether intraoperative hypothermia or hyperthermia is associated with postoperative infections in infants. METHODS We conducted a retrospective review of patients ≤6 months old who underwent surgical procedures from November 2013 to October 2015 at a Level I ACS Children's Surgical Center. The outcome was infections within 30 days after operation, with particular attention to SSI. Data obtained included weight and age at surgery, American Society of Anesthesiologists (ASA) physiologic status, wound class, case length, blood transfusion within 72 h of surgery, and administration of prophylactic antibiotics. Temperatures were classified as hypothermia (T < 36 °C), normothermia (T = 36.0 to 37.9 °C), and hyperthermia (T ≥ 38 °C). RESULTS The 885 patients had 25 SSIs (2.8%) and 11 nonsurgical site infections (1.2%). On univariate analysis, weight at surgery, higher ASA, perioperative transfusions, and longer case length were associated with higher rate of SSI. Higher median Thigh, higher median T low, and any hyperthermia were associated with higher rate of SSI. On multivariable logistic regression adjusted analyses, hyperthermia at any time during the case was associated with SSI (OR 3.47, [95% CI 1.34, 9.04], p = 0.011). Transfusions were also associated with higher SSI rates (OR 3.60 [95% CI, 1.28, 10.3], p = 0.016). CONCLUSIONS Intraoperative hyperthermia is associated with increased SSI rates in infants. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sarah Walker
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Ruchi Amin
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Marjorie J Arca
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Ankur Datta
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
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Catania VD, Boscarelli A, Lauriti G, Morini F, Zani A. Risk Factors for Surgical Site Infection in Neonates: A Systematic Review of the Literature and Meta-Analysis. Front Pediatr 2019; 7:101. [PMID: 30984722 PMCID: PMC6449628 DOI: 10.3389/fped.2019.00101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/05/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose: Surgical site infections (SSI) contribute to postoperative morbidity and mortality in children. Our aim was to evaluate the prevalence and identify risk factors for SSI in neonates. Methods: Using a defined strategy, three investigators searched articles on neonatal SSI published since 2000. Studies on neonates and/or patients admitted to neonatal intensive care unit following cervical/thoracic/abdominal surgery were included. Risk factors were identified from comparative studies. Meta-analysis was conducted according to PRISMA guidelines using RevMan 5.3. Data are (mean ± SD) prevalence. Results: Systematic review-of 885 abstracts screened, 48 studies (27,760 neonates) were included. The incidence of SSI was 5.6% (1,564 patients). SSI was more frequent in males (61.8%), premature babies (77.4%), and following gastrointestinal surgery (95.4%). Meta-analysis-10 comparative studies (16,442 neonates; 946 SSI 5.7%) showed that predictive factors for SSI development were gestational age, birth weight, age at surgery, length of surgical procedure, number of procedure per patient, length of preoperative hospital stay, and preoperative sepsis. Conversely, preoperative antibiotic use was not significantly associated with development of SSI. Conclusions: Younger neonates and those undergoing abdominal procedures are at higher risk for SSI. Given the lack of evidence-based literature, prospective studies may help determine the risk factors for SSI in neonates.
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Affiliation(s)
- Vincenzo Davide Catania
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Alessandro Boscarelli
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppe Lauriti
- Department of Pediatric Surgery, Spirito Santo Hospital and G. d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Francesco Morini
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Knell J, Han SM, Jaksic T, Modi BP. In Brief. Curr Probl Surg 2019. [DOI: 10.1067/j.cpsurg.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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Affiliation(s)
- Jamie Knell
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Sam M Han
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Tom Jaksic
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital, Boston, MA; Harvard Medical School, Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA
| | - Biren P Modi
- Harvard Medical School, Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA.
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Knell J, Han SM, Jaksic T, Modi BP. WITHDRAWN: In Brief. Curr Probl Surg 2018. [DOI: 10.1067/j.cpsurg.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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