From the Guidelines
Children are not inherently at a higher risk of surgical site infections (SSIs) compared to adults, but certain pediatric populations and factors can increase their susceptibility. The development of SSI is multifactorial, and it may be related to patient’s risk factors such as age, comorbidities, smoking habit, obesity, malnutrition, immunosuppression, malignancies, and the class of contamination of the wound 1. Some pediatric populations, such as neonates, infants under 1 year, immunocompromised children, and those with complex medical conditions, may face increased infection risks due to their developing immune systems and other underlying health issues. Factors that elevate SSI risk in children include malnutrition, prolonged hospital stays, complex surgeries, and contaminated wounds, similar to those in adults 1. Prevention strategies are crucial and include appropriate preoperative antibiotics, proper skin preparation, meticulous surgical technique, and good postoperative wound care. For example, preoperative antibiotics such as cefazolin (dosing not specified in the provided evidence) may be used for clean procedures, with alternatives like clindamycin for penicillin-allergic patients, though specific dosing recommendations for children are not provided in the given study 1. Proper nutrition support before surgery, minimizing hospital stays, and careful attention to wound care instructions are particularly important in pediatric surgical patients to reduce the risk of SSI. Early recognition of SSI signs, such as increasing pain, redness, drainage, and fever, is essential for prompt treatment and improving outcomes in children. Given the potential for increased risk in certain pediatric populations and the importance of prevention, it is critical to apply evidence-based strategies to minimize the incidence of SSIs in children undergoing surgery, as the consequences of SSIs can include prolonged hospital stay, increased intensive care unit admissions, hospital readmissions after surgery, and significantly increased costs, as well as deleterious effects on quality of life 1.
From the Research
Risk of Surgical Site Infection in Children
- Children are at a significant risk of surgical site infections (SSIs), with rates similar to those of adults, but higher among neonates 2.
- The incidence of SSI in neonates is 5.6%, with higher frequencies in males, premature babies, and following gastrointestinal surgery 3.
- Risk factors for SSI development in neonates include gestational age, birth weight, age at surgery, length of surgical procedure, number of procedures per patient, length of preoperative hospital stay, and preoperative sepsis 3.
Comparison of SSI Rates in Children and Adults
- SSI rates among children are similar to those of adults, but the difficulty in treatment and prevention of SSIs in children usually results from the variety of pathogens causing the infection 2.
- The prognostic scores developed and validated for adults have not been adopted for children, and guidelines for the prevention of SSIs are not specifically related to pediatric patients and are not fully supported by evidence 2.
Prevention of SSIs in Children
- Prevention of SSIs requires addressing the causes at each phase of patient treatment, uniformly for both adults and children 2.
- The use of prophylactic antibiotics, such as cefazolin, is a standard for adults, but there is no clear agreement for children, and the use of antibiotic prophylactics varies between medical centers 2, 4, 5.
- A systematic registry of SSIs among children is required, along with rigorous investigation of risk factors and prevention program development 2.
Ambulatory Surgery and SSI Risk
- The weighted SSI incidence following pediatric ambulatory surgery is 2.00 SSI per 1,000 ambulatory surgeries, with integumentary surgeries having the highest weighted SSI incidence 6.
- Risk factors for SSI following ambulatory surgery in children include clean contaminated or contaminated wound class, other insurance type, and surgery on weekend day 6.