Surgical Site Infection in Children: Prospective Analysis of the Burden and Risk Factors in a Sub-Saharan African Setting
Surgical Site Infection in Children: Prospective Analysis of the Burden and Risk Factors in a Sub-Saharan African Setting
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DOI：
10.1089/sur.2007.082
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发表时间：
2009-04-01
影响因子：
2
通讯作者：
Nmadu, Paul T.
中科院分区：
文献类型：
--
作者：
Ameh, Emmanuel A.;Mshelbwala, Philip M.;Nmadu, Paul T.
背景：手术部位感染（SSI）大大增加了手术患者的发病率。我们的假设是SSI率在我们的环境中很高，但没有关于患病率和危险因素的数据。方法：对2001年1月至2005年9月接受外科手术的322例患儿（择期144例，急诊178例）进行前瞻性研究。所有清洁污染、污染和肮脏切口的患者均接受预防性抗生素治疗。数据收集使用的工具包括人口统计学、诊断、合并症、手术切口类型、手术性质、麻醉类型、围手术期抗生素使用和手术持续时间。术后还收集了SSI的发展、感染类型、相关体征、发现感染的日期、感染切口拭子培养结果、住院时间和结局等信息。分类变量采用卡方检验检验关联的显著性。显著性p值设为0.05。结果：76例（23.6%）患者发生SSI，其中男孩40例，女孩36例。发生SSI的患者中位年龄为9个月（2天-12岁），未发生SSI的患者中位年龄为15个月（1天-13岁）。洁净切口的SSI率为14.3%，洁净污染切口为19.3%，污染切口为27.3%，脏污切口为60% （p < 0.05）。急诊感染率为25.8%，择期感染率为20.8% （p < 0.05）。手术时间为>= 2h组感染率为31%，手术时间< 2h组感染率为17.3% （p < 0.05）。56例（74.6%）SSI患者术后8天前检测到感染，32例（42.7%）患者切口培养细菌。SSI患者平均住院时间为26.1天（范围8 ~ 127天），无SSI患者平均住院时间为18.0天（范围1 ~ 99天）（p < 0.05）。SSI患者的死亡率为10.5%，其中8例死亡中有6例与SSI直接相关，而无SSI患者的死亡率为4.1% （p < 0.05）。结论：该地区的SSI负担较高。切口污染程度和手术时间长（>= 2 h）是重要的危险因素。
Background: Surgical site infections (SSI) add substantially to the morbidity of surgical patients. Our hypothesis was that the SSI rate is high in our setting, but there were no data regarding the prevalence and risk factors.Methods: Three hundred twenty-two children who had surgery (elective 144, emergency 178) between January, 2001 and September, 2005 were studied prospectively. All patients with clean-contaminated, contaminated, and dirty incisions received prophylactic antibiotics. Data were collected using a tool that captured demographics, diagnosis, co-morbid conditions, type of surgical incision, nature of surgery, type of anesthesia, use of perioperative antibiotics, and duration of surgery. Information also was collected postoperatively on the development of SSI, type of infection, associated signs, the day the infection was identified, the findings in cultures of swabs from infected incisions, duration of hospital stay, and outcome. The chi-square test for categorical variables was used to test for significance of association. The p value for significance was set at 0.05.Results: Seventy-six patients (23.6%) consisting of 40 boys and 36 girls developed SSI. The median age was nine months (range, 2 days-12 years) for those who developed SSI and 15 months (range, 1 day-13 years) for those who did not. The SSI rate was 14.3% in clean incisions, 19.3% in clean-contaminated incisions, 27.3% in contaminated incisions, and 60% in dirty incisions (p < 0.05). The infection rate was 25.8% in emergency procedures and 20.8% in elective procedures (p > 0.05). The infection rate was 31% in operations lasting >= 2 h and 17.3% in operations lasting < 2 h (p < 0.05). Infection was detected before the eighth postoperative day in 56 of the patients (74.6%) with SSI, and bacteria were cultured from the incision in 32 patients (42.7%). The average length of stay was 26.1 days (range, 8-127 days) in patients with SSI and 18.0 days (range, 1-99 days) in those without SSI (p < 0.05). The mortality rate of patients with SSI was 10.5%, with six of the eight deaths related directly to the SSI, compared with a mortality rate of 4.1% in patients without SSI (p < 0.05).Conclusion: The burden of SSI in this setting is high. The degree of incisional contamination and a long duration of surgery (>= 2 h) are important risk factors.