入住新生儿重症监护病房的婴儿手术部位感染
Surgical site infections in infants admitted to the neonatal intensive care unit.
作者信息
Segal Ilan, Kang Christine, Albersheim Susan G, Skarsgard Erik D, Lavoie Pascal M
机构信息
Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada V6H 3 N1; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V6T 1ZA; The Barzilai Medical Center Ashkelon; Ben Gurion University of the Negev, Ashkelon 78278, Israel.
Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada V6H 3 N1.
出版信息
J Pediatr Surg. 2014 Mar;49(3):381-4. doi: 10.1016/j.jpedsurg.2013.08.001.
BACKGROUND
Surgical interventions are common in infants admitted to the neonatal intensive care unit (NICU). Despite our awareness of the broad impact of surgical site infection (SSI), there are little data in neonates. Our objective was to determine the rate and clinical impact of SSI in infants admitted to the NICU.
METHODS
Provincial population-based study of infants admitted to a tertiary care NICU. SSI, explicitly defined, was included if it occurred within 30 days of a skin/mucosal-breaking surgical intervention.
RESULTS
Among 724 infants who underwent 1039 surgical interventions very low birth weight (VLBW) infants were over-represented. The overall SSI rate was 4.3 per 100 interventions [CI 95% 3.2 to 5.7], up to 19 per 100 dirty interventions (wound class 4) [CI 95% 4.0 to 46]. Rates were higher in infants following gastroschisis closure (13 per 100 infants [CI 95% 5.8 to 24]), whereas they were generally low following a ligation of a ductus arteriosus. Infants with SSI required longer hospitalization after adjusting for co-morbidities (p<0.001).
CONCLUSIONS
Data from this relatively large contemporary study suggest that SSI rates in the NICU setting are more comparable to the pediatric age group. However, VLBW infants and those undergoing gastroschisis closure represent high risk groups.
背景
手术干预在入住新生儿重症监护病房（NICU）的婴儿中很常见。尽管我们意识到手术部位感染（SSI）的广泛影响，但关于新生儿的相关数据却很少。我们的目的是确定入住NICU的婴儿中SSI的发生率及其临床影响。
方法
对入住三级护理NICU的婴儿进行基于省级人群的研究。明确界定的SSI如果发生在皮肤/黏膜破损的手术干预后30天内则纳入研究。
结果
在接受1039次手术干预的724名婴儿中，极低出生体重（VLBW）婴儿占比过高。总体SSI发生率为每100次干预4.3例[95%置信区间（CI）3.2至5.7]，每100次清洁-污染手术（伤口分类4级）高达19例[95%CI 4.0至46]。腹裂修补术后婴儿的发生率较高（每100名婴儿13例[95%CI 5.8至24]），而动脉导管结扎术后的发生率通常较低。在对合并症进行校正后，发生SSI的婴儿住院时间更长（p<0.001）。
结论
这项相对大型的当代研究数据表明，NICU环境中的SSI发生率与儿童年龄组更具可比性。然而，VLBW婴儿和接受腹裂修补术的婴儿是高危群体。
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