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
doi: 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:

Antibiotic prophylaxis – Intensive care units – Medical risk factors – Nosocomial infections – Pediatric infections – Pediatric surgery – Pediatrics – Surgical and invasive medical procedures


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