Analysis of Risk Factors for Multiantibiotic-Resistant Infections Among Surgical Patients at a Children's Hospital

Association between bacterial resistance profile and the development of intra-abdominal abscesses in pediatric patients with perforated appendicitis: cohort study

PURPOSE

The objective of this study was to determine the association between the presence of a microorganism resistant to the antibiotic used in empirical therapy and the development of intra-abdominal abscesses in children with perforated appendicitis.

METHODS

A prospective cohort study was conducted in patients under 18 years of age who underwent laparoscopic appendectomy between November 1, 2019, and September 30, 2020, in whom perforated appendicitis was documented intraoperatively. Peritoneal fluid samples were taken for bacteria culture purposes, and clinical and microbiological data were collected from all patients.

RESULTS

A total of 232 patients were included in the study. The most isolated microorganisms were Escherichia coli (80.14%) and Pseudomonas aeruginosa (7.45%). In addition, 5.31% of E. coli isolates were classified as ESBL-producing organisms. No association was found between a germ resistant to empiric antimicrobial therapy and the development of a postoperative intra-abdominal abscess. Multivariate analysis showed that being a high-risk patient on admission (OR 2.89 (p = 0.01)) was associated with the development of intra-abdominal abscesses postoperatively.

CONCLUSION

E. coli was the most commonly isolated microorganism, with a low rate of ESBL-producing isolates. No association between resistance and risk of postoperative intra-abdominal abscess was found. However, it was identified that being a high-risk patient on admission was associated with this complication.

TYPE OF STUDY

Prognosis study.

LEVEL OF EVIDENCE

Level I.

Surgical site infections caused by multi-drug resistant organisms: a case-control study in general surgery

Multi-drug resistant organisms (MDR-Os) are emerging as a significant cause of surgical site infections (SSI), but clinical outcomes and risk factors associated to MDR-Os-SSI have been poorly investigated in general surgery. Aims were to investigate risk factors, clinical outcomes and costs of care of multi-drug resistant organisms (MDR-Os-SSI) in general surgery. From January 2018 to December 2019, all the consecutive, unselected patients affected by MDR-O SSI were prospectively evaluated. In the same period, patients with non-MDR-O SSI and without SSI, matched for clinical and surgical data were used as control groups. Risk factors for infection, clinical outcome, and costs of care were compared by univariate and multivariate analysis. Among 3494 patients operated on during the study period, 47 presented an MDR-O SSI. Two control groups of 47 patients with non-MDR-O SSI and without SSI were identified. MDR-Os SSI were caused by poly-microbial etiology, meanly related to Gram negative Enterobacteriales. MDR-Os-SSI were related to major postoperative complications. At univariate analysis, iterative surgery, open abdomen, intensive care, hospital stay, and use of aggressive and expensive therapies were associated to MDR-Os-SSI. At multivariate analysis, only iterative surgery and the need of total parenteral and immune-nutrition were significantly associated to MDR-Os-SSI. The extra-cost of MDR-Os-SSI treatment was 150% in comparison to uncomplicated patients. MDR-Os SSI seems to be associated with major postoperative complications and reoperative surgery, they are demanding in terms of clinical workload and costs of care, they are rare but increasing, and difficult to prevent with current strategies.

Antimicrobial surgical prophylaxis: Still an issue in paediatrics

OBJECTIVES

Antimicrobial prophylaxis (AP) is an important means of reducing surgical site infections. The goal of this study was to evaluate the perioperative AP in paediatric practice and its compliance with surgical prophylaxis guidelines.

METHODS

A prospective study was conducted at Gazi University Faculty of Medicine, between September 2015 and April 2016. Paediatric patients who underwent surgical procedures were included in the study. Surgical AP was evaluated.

RESULTS

During the entire study period, 466 children underwent surgery at our centre; 433 (92.7%) received antimicrobial prophylaxis. Overall adherence to the guidelines regarding surgical prophylaxis was 22.1%. The rate of administration of surgical prophylaxis was significantly lower, and the duration was shorter when the surgical procedure was clean (P = 0.002). When the duration of the procedure was longer, the rate of administration of prophylaxis was higher (P = 0.000). The duration of postoperative prophylaxis was longer than recommended in 72.2% of the patients. In the multivariate analysis, application errors increased with longer surgical time (P = 0.01, OR 2.18, 95% CI 1.19-4.03).

CONCLUSIONS

High rates of misapplication of antimicrobial surgical prophylaxis were observed in this study. Awareness and usage of guidelines should be encouraged. The education of clinicians should be supported by studies regarding surgical prophylaxis in children.