Preoperative and operation-related risk factors for postoperative nosocomial infections in pediatric patients: A retrospective cohort study
Autoři:
Kuanrong Li aff001; Xiaojun Li aff001; Wenyue Si aff001; Yanqin Cui aff002; Huimin Xia aff003; Xin Sun aff004; Xingrong Song aff005; Huiying Liang aff001
Působiště autorů:
Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
aff001; Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
aff002; Guangdong Province Key Laboratory of Structural Birth Defects, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
aff003; Department of Medical Administration, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
aff004; Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
aff005
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0225607
Souhrn
Background
Pediatric patients undergoing invasive operations bear extra risk of developing nosocomial infections (NIs). However, epidemiological evidence of the underlying risk factors, which is needed for early prevention, remains limited.
Methods
Using data from the electronic medical records and the NI reporting system of a tertiary pediatric hospital, we conducted a retrospective analysis to identify preoperative and operation-related risk factors for postoperative NIs. Multivariable accelerated failure time models were fitted to select independent risk factors. The performance of these factors in risk stratification was examined by comparing the empirical risks between the model-defined low- and high-risk groups.
Results
A total of 18,314 children undergoing invasive operations were included for analysis. After a follow-up period of 154,700 patient-days, 847 postoperative NIs were diagnosed. The highest postoperative NI rate was observed for operations on hemic and lymphatic system. Surgical site infections were the NI type showing the highest overall risk; however, patients were more likely to develop urinary tract infections in the first postoperative week. Older age, higher weight-for-height z-score, longer preoperative ICU stay, preoperative enteral nutrition, same-day antibiotic prophylaxis, and higher hemoglobin level were associated with delayed occurrence of postoperative NIs, while longer preoperative hospitalization, longer operative duration, and higher American Society of Anesthesiologists score showed acceleration effects. Risk stratification based on these factors in an independent patient population was moderate, resulting in a high-risk group in which 72% of the postoperative NIs were included.
Conclusions
Our findings suggest that pediatric patients undergoing invasive operations and at high risk of developing postoperative NIs are likely to be identified using basic preoperative and operation-related risk factors, which together might lead to moderately accurate risk stratification but still provide valuable information to guide early and judicious prevention.
Klíčová slova:
Pediatrics – Surgical and invasive medical procedures – Medical risk factors – Pediatric infections – Intensive care units – Nosocomial infections – Pediatric surgery – Antibiotic prophylaxis
Zdroje
1. National and state healthcare associated infections: progress report. Center for Disease Control and Prevention. 2016.
2. Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011; 377(9761):228–41. doi: 10.1016/S0140-6736(10)61458-4 21146207
3. European Center for Disease Prevention and Control. Annual Epidemiological Report on Communicable Diseases in Europe 2008. In. Stockholm. 2008.
4. Rosenthal VD, Al-Abdely HM, El-Kholy AA, AlKhawaja SAA, Leblebicioglu H, Mehta Y, et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010–2015: Device-associated module. American journal of infection control. 2016; 44(12):1495–504. doi: 10.1016/j.ajic.2016.08.007 27742143
5. National Nosocomial Infections Surveillance. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. American journal of infection control. 2004; 32(8):470–85. doi: 10.1016/S0196655304005425 15573054
6. Raymond J, Aujard Y. Nosocomial infections in patients: a European, multicenter prospective study. European Study Group. Infection control and hospital epidemiology. 2000; 21(4): 260–63. doi: 10.1086/501755 10782588
7. Kamp-Hopmans TE, Blok HE, Troelstra A, Gigengack-Baars AC, Weersink AJ, Vandenbroucke-Grauls CM, et al. Surveillance for hospital-acquired infections on surgical wards in a Dutch university hospital. Infection control and hospital epidemiology. 2003; 24(8):584–90. doi: 10.1086/502258 12940579
8. Hooton TM, Haley RW, Culver DH, White JW, Morgan WM, Carroll RJ. The joint associations of multiple risk factors with the occurrence of nosocomial infection. The American journal of medicine. 1981;70(4):960–70. doi: 10.1016/0002-9343(81)90562-3 7211932
9. Vazquez-Aragon P, Lizan-Garcia M, Cascales-Sanchez P, Villar-Canovas MT, Garcia-Olmo D. Nosocomial infection and related risk factors in a general surgery service: a prospective study. The Journal of infection. 2003;46(1):17–22. doi: 10.1053/jinf.2002.1073 12504604
10. Garibaldi RA, Cushing D, Lerer T. Risk factors for postoperative infection. The American journal of medicine. 1991;91(3B):158S–63S. doi: 10.1016/0002-9343(91)90362-2 1928157
11. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control. 2008;36(5):309–32. doi: 10.1016/j.ajic.2008.03.002 18538699
12. Nelson W. Theory and applications of hazard plotting for censored failure data. Technometrics. 1972;14:945–65.
13. Onen A, Cigdem MK, Geyik MF, Kokoglu OF, Otcu S, Ozturk H, Dokucu AI. Epidemiology and control of nosocomial infections in pediatric surgery. The Journal of hospital infection. 2002; 52(3):166–70. doi: 10.1053/jhin.2002.1285 12419267
14. Solomons NW. Malnutrition and infection: an update. The British journal of nutrition. 2007; 98 Suppl 1:S5–10.
15. Schaible UE, Kaufmann SH. Malnutrition and infection: complex mechanisms and global impacts. PLoS medicine. 2007;4(5):e115. doi: 10.1371/journal.pmed.0040115 17472433
16. Goldmann DA, Durbin WA Jr., Freeman J. Nosocomial infections in a neonatal intensive care unit. The Journal of infectious diseases. 1981;144(5):449–59. doi: 10.1093/infdis/144.5.449 7310176
17. Rodriguez-Garcia J, Gamino-Iriarte A, Rodea-Montero ER. Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital. PloS one. 2015;10(3):e0118980. doi: 10.1371/journal.pone.0118980 25803860
18. Hassan TH, Badr MA, Karam NA, Zkaria M, El Saadany HF, Abdel Rahman DM, et al. Impact of iron deficiency anemia on the function of the immune system in children. Medicine. 2016; 95(47):e5395. doi: 10.1097/MD.0000000000005395 27893677
19. Singh-Naz N, Sprague BM, Patel KM, Pollack MM. Risk factors for nosocomial infection in critically ill children: a prospective cohort study. Critical care medicine. 1996;24(5):875–8. doi: 10.1097/00003246-199605000-00024 8706468
20. Gilio AE, Stape A, Pereira CR, Cardoso MF, Silva CV, Troster EJ. Risk factors for nosocomial infections in a critically ill population: a 25-month prospective cohort study. Infection control and hospital epidemiology. 2000;21(5):340–2. doi: 10.1086/501770 10823571
21. Bueno Cavanillas A, Rodriguez-Contreras R, Delgado Rodriguez M, Moreno Abril O, Lopez Gigosos R, Guillen Solvas J, Galvez Vargas R. Preoperative stay as a risk factor for nosocomial infection. European journal of epidemiology. 1991;7(6):670–6. doi: 10.1007/bf00218680 1783060
22. Campanozzi A, Russo M, Catucci A, Rutigliano I, Canestrino G, Giardino I, et al. Hospital-acquired malnutrition in children with mild clinical conditions. Nutrition. 2009; 25(5):540–7. doi: 10.1016/j.nut.2008.11.026 19230617
23. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ. 1994;308(6934):945–8. doi: 10.1136/bmj.308.6934.945 8173401
24. Heyland DK. Nutritional support in the critically ill patients. A critical review of the evidence. Crit Care Clin.1998;14(3):423–40. doi: 10.1016/s0749-0704(05)70009-9 9700440
25. Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Critical care medicine. 2001;29(12):2264–70. doi: 10.1097/00003246-200112000-00005 11801821
26. Pingleton SK. Enteral Nutrition and Infection: Benefits and Risks. Update in Intensive Care and Emergency Medicine. 1991;14:581–9.
27. Netto R, Mondini M, Pezzella C, Romani L, Lucignano B, Pansani L, et al. Parenteral Nutrition Is One of the Most Significant Risk Factors for Nosocomial Infections in a Cardiac Intensive Care Unit. JPEN Journal of parenteral and enteral nutrition. 2017;41(4):612–8. doi: 10.1177/0148607115619416 26616137
28. Fonseca G, Burgermaster M, Larson E, Seres DS. The Relationship Between Parenteral Nutrition and Central Line-Associated Bloodstream Infections: 2009–2014. JPEN Journal of parenteral and enteral nutrition. 2018;42(1):171–5. doi: 10.1177/0148607116688437 29505142
29. Allen J, David M, Veerman JL. Systematic review of the cost-effectiveness of preoperative antibiotic prophylaxis in reducing surgical-site infection. BJS open. 2018;2(3):81–98. doi: 10.1002/bjs5.45 29951632
30. Rangel SJ, Fung M, Graham DA, Ma L, Nelson CP, Sandora TJ. Recent trends in the use of antibiotic prophylaxis in surgery. Journal of surgery. 2011;46(2):366–71.
31. Antimicrobial prophylaxis in pediatric surgical patients. Committee on Infectious Diseases, Committee on Drugs, and Section on Surgery. 1984;74(3):437–9. 6472979
32. Bratzler DW, Houck PM, Surgical Infection Prevention Guideline Writers. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. American journal of surgery. 2005;189(4):395–404. doi: 10.1016/j.amjsurg.2005.01.015 15820449
33. Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surgical infections. 2017; 18(6):722–35. doi: 10.1089/sur.2017.089 28832271
34. Levy SM, Holzmann-Pazgal G, Lally KP, Davis K, Kao LS, Tsao K. Quality check of a quality measure: surgical wound classification discrepancies impact risk-stratified surgical site infection rates in appendicitis. Journal of the American College of Surgeons. 2013; 217(6):969–73. doi: 10.1016/j.jamcollsurg.2013.07.398 24041560
35. Ortega G, Rhee DS, Papandria DJ, Yang J, Ibrahim AM, Shore AD, et al.An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. The Journal of surgical research. 2012;174(1):33–8. doi: 10.1016/j.jss.2011.05.056 21962737
36. Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. The American journal of medicine. 1991; 91(3B):152S–7S. doi: 10.1016/0002-9343(91)90361-z 1656747
Článok vyšiel v časopise
PLOS One
2019 Číslo 12
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Nejasný stín na plicích – kazuistika
- Fixní kombinace paracetamol/kodein nabízí synergické analgetické účinky
- Ne každé mimoděložní těhotenství musí končit salpingektomií
- Somatizace stresu – typické projevy a možnosti řešení