Preoperative and operation-related risk factors for postoperative nosocomial infections in pediatric patients: A retrospective cohort study

Clinical Impact and Risk Factors of Intensive Care Unit-Acquired Nosocomial Infection: A Propensity Score-Matching Study from 2018 to 2020 in a Teaching Hospital in China

Purpose

Nosocomial infection (NI) is associated with poor prognosis. The present study assessed the clinical and microbiological characteristics of NI patients in the intensive care unit (ICU) and investigated the clinical impact and risk factors for NI in ICU patients.

Patients and Methods

An observational study was conducted in an adult general ICU. The electronic medical records of all patients admitted to the ICU for >2 days from 2018-2020 were analyzed retrospectively. Multivariate regression models were used to analyze the risk factors for NI in ICU patients. Propensity score-matching (PSM) was used to control the confounding factors between the case and control groups, thus analyzing the clinical impact of NIs.

Results

The present study included 2425 patient admissions, of which 231 (9.53%) had NI. Acinetobacter baumannii (33.0%) was the most common bacteria. Long-term immunosuppressive therapy, disturbance of consciousness, blood transfusion, multiple organ dysfunction syndromes (MODS), treatment with three or more antibiotics, mechanical ventilation (MV), tracheotomy, the urinary catheter (UC), nasogastric catheter, and central venous catheter (CVC) were risk factors for NI in the ICU patients. After PSM, patients with NI had a prolonged length of stay (LOS) in the ICU and hospital, significant hospitalization expenses (all p<0.001), increased mortality (p=0.027), and predicted mortality (p=0.007). The differences in the ICU and hospital LOSs among three pathogens were statistically significant (p<0.001); the results of the Escherichia coli infection group were lower than the other two pathogenic groups.

Conclusion

NI was associated with poor outcomes. The risk factors for NI identified in this study provided further insight into preventing NI.

Presepsin as a promising biomarker for early detection of post-operative infection in children

Background

Post-operative systemic inflammation response syndrome (SIRS) is an event that results from surgical trauma, white blood cells contact activation, and intra-surgical bacterial translocation, which is difficult to distinguish from sepsis. Presepsin is a novel biomarker that is increased since the early stages of bacterial infection and can be used to confirm the diagnosis of post-operative infectious complications. This study aimed to investigate the diagnostic performance of presepsin for post-operative infectious complications compared to other well-known biomarkers.

Method

This cross-sectional study included 100 post-operative patients admitted to Cipto Mangunkusumo National Hospital and Bunda Hospital in Jakarta, Indonesia. The objective was to identify the optimal cutoff and trend of plasma presepsin concentration on the first and third day after surgery and to compare them with other biomarkers.

Result

Plasma presepsin level was higher in the infection group compared to the non-infection group (median 806.5 pg/ml vs. 717 pg/ml and 980 pg/ml vs. 516 pg/ml on the first and third day, respectively). Presepsin levels tended to increase on the third post-operative day (median + 252 pg/ml) in children with infection. The opposite trend was observed in the non-infection group from the first to the third day (median -222.5 pg/ml). Presepsin delta, a three-day difference between the first and third post-operative day, had the best diagnostic performance compared to other biomarkers (Area Under the Curve 0.825). The optimal cutoff for presepsin delta to diagnose post-operative infection was +90.5 pg/ml.

Conclusion

Serial assessments of presepsin levels on the first and third days post-surgery and their trends are helpful diagnostic markers for clinicians to detect post-operative infectious complications in children.

Management Outcome and Factors Associated with Pediatric Surgical Patient Admitted to Arbaminch General Hospital, Southern Ethiopia, 2021: Retrospective Cross-Sectional Study

Background

Pediatric surgical situations are often disregarded around the world, particularly in developing countries. The number of children hospitalized for surgical reasons has climbed dramatically. There is extensive research on the management outcome of pediatric surgical admissions in industrialized countries, but developing countries have paid little attention to it. Furthermore, to the best of the authors' knowledge, there has been no research in the study area on the management outcome of pediatric surgical patient admission.

Objective

To assess management outcome and factors associated with pediatric surgical patients admitted to Arbaminch General Hospital, Southern Ethiopia, 2021.

Method

An institution-based retrospective cross-sectional study design was employed among 265 children with surgical problems. Data were collected from patients' medical records using pretested data collection checklist. Epi Data 4.2 was used to enter data, and data were exported to SPSS version 25 for analysis. Those variables with P-value ≤0.25 in bivariable analysis were entered into multivariable logistic regression analysis, and statistical significance was declared at P < 0.05.

Result

A total of 265 surgically admitted children were included in this study. About 26% of study subjects were discharged with unfavorable management outcome. Children admitted due to trauma cause (AOR: 5.753, 95% CI: 2.366–13.987), children with a preexisting medical condition (AOR: 3.240, 95% CI: 1.436–7.310), children with an early complication (AOR: 2.515, 95% CI: 1.130–5.599), presenting to hospital ≥24 hr after the onset (AOR:8.351, 95% CI: 2.089–33.381), hospital stay >7 days (AOR: 10.671, 95% CI: 1.363–83.546), and children treated with surgery (AOR: 2.742, 95% CI: 1.137–6.611) were associated with unfavorable management outcome. Conclusion and recommendations: Twenty-six percent of patients were discharged with unfavorable outcome. Reasons for admission, preexisting medical condition, early complications, duration of hospital presentation, length of hospitalization, and type of management were all linked to the outcome of pediatric surgical admission. To have a good outcome, early identification and treatment of the cause are required, as well as well-equipped surgical care centers.

Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse.

Antibiotics for hospital-acquired pneumonia in neonates and children

BACKGROUND

Hospital-acquired pneumonia is one of the most common hospital-acquired infections in children worldwide. Most of our understanding of hospital-acquired pneumonia in children is derived from adult studies. To our knowledge, no systematic review with meta-analysis has assessed the benefits and harms of different antibiotic regimens in neonates and children with hospital-acquired pneumonia.

OBJECTIVES

To assess the beneficial and harmful effects of different antibiotic regimens for hospital-acquired pneumonia in neonates and children.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, three other databases, and two trial registers to February 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies.

SELECTION CRITERIA

We included randomised clinical trials comparing one antibiotic regimen with any other antibiotic regimen for hospital-acquired pneumonia in neonates and children.

DATA COLLECTION AND ANALYSIS

Three review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of the evidence using the GRADE approach. Our primary outcomes were all-cause mortality and serious adverse events; our secondary outcomes were health-related quality of life, pneumonia-related mortality, non-serious adverse events, and treatment failure. Our primary time point of interest was at maximum follow-up.

MAIN RESULTS

We included four randomised clinical trials (84 participants). We assessed all trials as having high risk of bias. We did not conduct any meta-analyses, as the included trials did not compare similar antibiotic regimens. Each of the four trials assessed a different comparison, as follows: cefepime versus ceftazidime; linezolid versus vancomycin; meropenem versus cefotaxime; and ceftobiprole versus cephalosporin. Only one trial reported our primary outcomes of all-cause mortality and serious adverse events. Three trials reported our secondary outcome of treatment failure. Two trials primarily included community-acquired pneumonia and hospitalised children with bacterial infections, hence the children with hospital-acquired pneumonia constituted subgroups of the total sample sizes. Where outcomes were reported, the certainty of the evidence was very low for each of the comparisons. We are unable to draw meaningful conclusions from the numerical results. None of the included trials assessed health-related quality of life, pneumonia-related mortality, or non-serious adverse events.

AUTHORS' CONCLUSIONS

The relative beneficial and harmful effects of different antibiotic regimens remain unclear due to the very low certainty of the available evidence. The current evidence is insufficient to support any antibiotic regimen being superior to another. Randomised clinical trials assessing different antibiotic regimens for hospital-acquired pneumonia in children and neonates are warranted.