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01-11-2018 | Original Article

Contaminated or dirty wound operations and methicillin-resistant Staphylococcus aureus (MRSA) colonization during hospitalization may be risk factors for surgical site infection in neonatal surgical patients

Authors: Mikihiro Inoue, Keiichi Uchida, Takashi Ichikawa, Yuka Nagano, Kohei Matsushita, Yuhki Koike, Yoshiki Okita, Yuji Toiyama, Toshimitsu Araki, Masato Kusunoki

Published in: Pediatric Surgery International | Issue 11/2018

Abstract

Purpose

Establishment of evidence-based best practices for preventing surgical site infection (SSI) in neonates is needed. SSI in neonates, especially those with a low birth weight, is potentially life-threatening. We aimed to identify risk factors associated with SSI in neonates.

Methods

A retrospective review was performed using 2007–2016 admission data from our institution. Neonatal patients who were admitted to the neonatal intensive care unit and underwent surgery were evaluated for a relationship between development of SSI and perinatal or perioperative factors and methicillin-resistant Staphylococcus aureus (MRSA) colonization during hospitalization.

Results

One hundred and eighty-one patients were enrolled in this study. Overall SSI incidence was 8.8%. Univariate analysis showed that SSI was significantly more frequent in both patients with contaminated or dirty wound operations and patients with MRSA colonization during hospitalization. Both of these factors were identified as independent risk factors for SSI by multivariate analysis [hazard ratio (HR): 6.1, 95% confidence interval (CI) 2.0–19.9; HR: 3.3, 95% CI 1.1–10.4, respectively].

Conclusions

This study identified contaminated or dirty wound operations and MRSA colonization during hospitalization as risk factors for SSI in neonates. MRSA colonization may be a preventable factor, unlike previously reported risk factors.

Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332CrossRef

Leaper DJ, van Goor H, Reilly J (2004) Surgical site infection—a European perspective of incidence and economic burden. Int Wound J 1:247–273CrossRef

Segal I, Kang C, Albersheim SG et al (2014) Surgical site infections in infants admitted to the neonatal intensive care unit. J Pediatr Surg 49:381–384CrossRef

Lejus C, Dumont R, Gall CL et al (2013) A preoperative stay in an intensive care unit is associated with an increased risk of surgical site infection in neonates. J Pediatr Surg 48:1503–1508CrossRef

Vu LT, Vittinghoff E, Nobuhara KK et al (2014) Surgical site infections in neonates and infants: is antibiotic prophylaxis needed for longer than 24 h? Pediatr Surg Int 30:587–592CrossRef

Clements KE, Fisher M, Quaye K et al (2016) Surgical site infections in the NICU. J Pediatr Surg 51:1405–1408CrossRef

Garner JS (1986) CDC guideline for prevention of surgical wound infections, 1985. Supercedes guideline for prevention of surgical wound infections published in 1982. Revis Infect Control 7:193–200 (originally published in 1995)CrossRef

Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608CrossRef

Umscheid CA, Mitchell MD, Doshi JA et al (2011) Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 32:101–114CrossRef

10.

Berríos-Torres SI, Umscheid CA, Bratzler DW, Healthcare Infection Control Practices Advisory Committee et al (2017) Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152:784–791CrossRef

11.

World Health Organization (2016) Global guidelines for the prevention of surgical site infection. World Health Organization, Geneva

12.

Katayanagi T (2015) Nasal methicillin-resistant S. aureus is a major risk for mediastinitis in pediatric cardiac surgery. Ann Thorac Cardiovasc Surg 21:37–44CrossRef

13.

Huddleston CB (2004) Mediastinal wound infections following pediatric cardiac surgery. Semin Thorac Cardiovasc Surg 16:108–112CrossRef

14.

Walrath JJ, Hennrikus WL, Zalonis C et al (2016) The prevalence of MRSA nasal carriage in preoperative pediatric orthopaedic patients. Adv Orthop 2016:5646529CrossRef

15.

Shimizu A, Shimizu K, Nakamura T (2008) Non-pathogenic bacterial flora may inhibit colonization by methicillin-resistant Staphylococcus aureus in extremely low birth weight infants. Neonatology 93:158–161CrossRef

16.

Uehara Y, Kikuchi K, Nakamura T et al (2001) H(2)O(2) produced by viridans group streptococci may contribute to inhibition of methicillin-resistant Staphylococcus aureus colonization of oral cavities in newborns. Clin Infect Dis 32:1408–1413CrossRef

17.

Uehara Y, Kikuchi K, Nakamura T et al (2001) Inhibition of methicillin-resistant Staphylococcus aureus colonization of oral cavities in newborns by viridans group streptococci. Clin Infect Dis 32:1399–1407CrossRef

18.

Mitsuoka T (2014) Establishment of intestinal bacteriology. Biosci Microbiota Food Health 33:99–116CrossRef

Title: Contaminated or dirty wound operations and methicillin-resistant Staphylococcus aureus (MRSA) colonization during hospitalization may be risk factors for surgical site infection in neonatal surgical patients
Authors: Mikihiro Inoue
Keiichi Uchida
Takashi Ichikawa
Yuka Nagano
Kohei Matsushita
Yuhki Koike
Yoshiki Okita
Yuji Toiyama
Toshimitsu Araki
Masato Kusunoki
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 11/2018
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-018-4338-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Contaminated or dirty wound operations and methicillin-resistant Staphylococcus aureus (MRSA) colonization during hospitalization may be risk factors for surgical site infection in neonatal surgical patients

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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