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. 2019 Dec 23;14(12):e0225607.
doi: 10.1371/journal.pone.0225607. eCollection 2019.

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

Kuanrong Li  1 , Xiaojun Li  1 , Wenyue Si  1 , Yanqin Cui  2 , Huimin Xia  3 , Xin Sun  4 , Xingrong Song  5 , Huiying Liang  1
Affiliations

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

Kuanrong Li et al. PLoS One. .

Abstract

Background: Pediatric patients undergoing invasive operations bear extra risk of developing nosocomial infections (NIs). However, epidemiological evidence of the underlying risk factors, which is needed for early prevention, remains limited.

Methods: Using data from the electronic medical records and the NI reporting system of a tertiary pediatric hospital, we conducted a retrospective analysis to identify preoperative and operation-related risk factors for postoperative NIs. Multivariable accelerated failure time models were fitted to select independent risk factors. The performance of these factors in risk stratification was examined by comparing the empirical risks between the model-defined low- and high-risk groups.

Results: A total of 18,314 children undergoing invasive operations were included for analysis. After a follow-up period of 154,700 patient-days, 847 postoperative NIs were diagnosed. The highest postoperative NI rate was observed for operations on hemic and lymphatic system. Surgical site infections were the NI type showing the highest overall risk; however, patients were more likely to develop urinary tract infections in the first postoperative week. Older age, higher weight-for-height z-score, longer preoperative ICU stay, preoperative enteral nutrition, same-day antibiotic prophylaxis, and higher hemoglobin level were associated with delayed occurrence of postoperative NIs, while longer preoperative hospitalization, longer operative duration, and higher American Society of Anesthesiologists score showed acceleration effects. Risk stratification based on these factors in an independent patient population was moderate, resulting in a high-risk group in which 72% of the postoperative NIs were included.

Conclusions: Our findings suggest that pediatric patients undergoing invasive operations and at high risk of developing postoperative NIs are likely to be identified using basic preoperative and operation-related risk factors, which together might lead to moderately accurate risk stratification but still provide valuable information to guide early and judicious prevention.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Risk of developing NIs in the first postoperative week, stratified by operative site (plot A) and by infection site (plot B). BSI (bloodstream infection), GI (gastrointestinal infection), LRI (lower respiratory tract infection), NI (nosocomial infection), SSI (surgical site infection), URI (upper respiratory tract infection, (UTI) urinary tract infection.
Fig 2
Fig 2. Postoperative NI risk in the low-risk group (2,192 patients including 21 NIs) and the high-risk group (2,191 patients including 79 NIs), stratified using the median of the risk score derived from the reduced AFT modela.
aAnalysis was done in an independent data set of patients undergoing invasive operation between January and May, 2019 (n = 4,383). NI (nosocomial infection).
See this image and copyright information in PMC

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