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Pediatric Surgery International

, Volume 34, Issue 11, pp 1209–1214 | Cite as

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

  • Mikihiro Inoue
  • Keiichi Uchida
  • Takashi Ichikawa
  • Yuka Nagano
  • Kohei Matsushita
  • Yuhki Koike
  • Yoshiki Okita
  • Yuji Toiyama
  • Toshimitsu Araki
  • Masato Kusunoki
Original Article

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.

Keywords

Surgical site infection Methicillin-resistant Staphylococcus aureus Wound classification Neonates Neonatal surgery 

Notes

Acknowledgements

We thank Sarah Bubeck, Ph.D., from Edanz Group (http://www.edanzediting.com /ac), for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required.

Informed consent

Written informed consent was obtained from all parents or guardians of patients enrolled in this study.

References

  1. 1.
    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 36:309–332CrossRefGoogle Scholar
  2. 2.
    Leaper DJ, van Goor H, Reilly J (2004) Surgical site infection—a European perspective of incidence and economic burden. Int Wound J 1:247–273CrossRefGoogle Scholar
  3. 3.
    Segal I, Kang C, Albersheim SG et al (2014) Surgical site infections in infants admitted to the neonatal intensive care unit. J Pediatr Surg 49:381–384CrossRefGoogle Scholar
  4. 4.
    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 48:1503–1508CrossRefGoogle Scholar
  5. 5.
    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 30:587–592CrossRefGoogle Scholar
  6. 6.
    Clements KE, Fisher M, Quaye K et al (2016) Surgical site infections in the NICU. J Pediatr Surg 51:1405–1408CrossRefGoogle Scholar
  7. 7.
    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)CrossRefGoogle Scholar
  8. 8.
    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 13:606–608CrossRefGoogle Scholar
  9. 9.
    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 32:101–114CrossRefGoogle Scholar
  10. 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 152:784–791CrossRefGoogle Scholar
  11. 11.
    World Health Organization (2016) Global guidelines for the prevention of surgical site infection. World Health Organization, GenevaGoogle Scholar
  12. 12.
    Katayanagi T (2015) Nasal methicillin-resistant S. aureus is a major risk for mediastinitis in pediatric cardiac surgery. Ann Thorac Cardiovasc Surg 21:37–44CrossRefGoogle Scholar
  13. 13.
    Huddleston CB (2004) Mediastinal wound infections following pediatric cardiac surgery. Semin Thorac Cardiovasc Surg 16:108–112CrossRefGoogle Scholar
  14. 14.
    Walrath JJ, Hennrikus WL, Zalonis C et al (2016) The prevalence of MRSA nasal carriage in preoperative pediatric orthopaedic patients. Adv Orthop 2016:5646529CrossRefGoogle Scholar
  15. 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 93:158–161CrossRefGoogle Scholar
  16. 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 32:1408–1413CrossRefGoogle Scholar
  17. 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 32:1399–1407CrossRefGoogle Scholar
  18. 18.
    Mitsuoka T (2014) Establishment of intestinal bacteriology. Biosci Microbiota Food Health 33:99–116CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Mikihiro Inoue
    • 1
  • Keiichi Uchida
    • 1
  • Takashi Ichikawa
    • 1
  • Yuka Nagano
    • 1
  • Kohei Matsushita
    • 1
  • Yuhki Koike
    • 1
  • Yoshiki Okita
    • 1
  • Yuji Toiyama
    • 1
  • Toshimitsu Araki
    • 1
  • Masato Kusunoki
    • 1
  1. 1.Department of Gastrointestinal and Pediatric SurgeryMie University Graduate School of MedicineTsuJapan

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