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Staphylococcus aureus infections after elective pediatric surgeries

Published online by Cambridge University Press:  11 March 2022

Iona M. Munjal
Affiliation:
Pfizer, Pearl River, New York
Jill Dreyfus*
Affiliation:
Premier Applied Sciences, Premier, Charlotte, North Carolina
Holly Yu
Affiliation:
Pfizer, Pearl River, New York
Elizabeth Begier
Affiliation:
Pfizer, Pearl River, New York
Alejandra Gurtman
Affiliation:
Pfizer, Pearl River, New York
Julie A. Gayle
Affiliation:
Premier Applied Sciences, Premier, Charlotte, North Carolina
Margaret A. Olsen
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
*
Author for correspondence: Jill Dreyfus, E-mail: Jill.Dreyfus@pfizer.com

Abstract

Objective:

To determine the 180-day cumulative incidence of culture-confirmed Staphylococcus aureus infections after elective pediatric surgeries.

Design:

Retrospective cohort study utilizing the Premier Healthcare database (PHD).

Setting:

Inpatient and hospital-based outpatient elective surgical discharges.

Patients:

Pediatric patients <18 years who underwent surgery during elective admissions between July 1, 2010, and June 30, 2015, at any of 181 PHD hospitals reporting microbiology results.

Methods:

In total, 74 surgical categories were defined using ICD-9-CM and CPT procedure codes. Microbiology results and ICD-9-CM diagnosis codes defined S. aureus infection types: bloodstream infection (BSI), surgical site infection (SSI), and other types (urinary tract, respiratory, and all other). Cumulative postsurgical infection incidence was calculated as the number of infections divided by the number of discharges with qualifying elective surgeries.

Results:

Among 11,874 inpatient surgical discharges, 180-day S. aureus infection incidence was 1.79% overall (1.00% SSI, 0.35% BSI, 0.45% other). Incidence was highest among children <2 years of age (2.76%) and lowest for those 10–17 years (1.49%). Among 50,698 outpatient surgical discharges, incidence was 0.36% overall (0.23% SSI, 0.05% BSI, 0.08% others); it was highest among children <2 years of age (0.57%) and lowest for those aged 10–17 years (0.30%). MRSA incidence was significantly higher after inpatient surgeries (0.68%) than after outpatient surgeries (0.14%; P < .0001). Overall, the median days to S. aureus infection was longer after outpatient surgery than after inpatient surgery (39 vs. 31 days; P = .0116).

Conclusions:

These findings illustrate the burden of postoperative S. aureus infections in the pediatric population, particularly among young children. These results underscore the need for continued infection prevention efforts and longer-term surveillance after surgery.

Type
Original Article
Copyright
© Pfizer, Inc., 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: Portions of this work were previously presented at the Pediatric Academic Societies Meeting on May 5–8, 2018, in Toronto, Canada.

References

Gould, JM, Hennessey, P, Kiernan, A, Safier, S, Herman, M. A novel prevention bundle to reduce surgical site infections in pediatric spinal fusion patients. Infect Control Hosp Epidemiol 2016;37:527534.CrossRefGoogle ScholarPubMed
Labbe, AC, Demers, AM, Rodrigues, R, Arlet, V, Tanguay, K, Moore, DL. Surgical-site infection following spinal fusion: a case-control study in a children’s hospital. Infect Control Hosp Epidemiol 2003;24:591595.CrossRefGoogle ScholarPubMed
Sherrod, BA, Rocque, BG. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery. J Neurosurg Pediatr 2017;19:421427.CrossRefGoogle ScholarPubMed
Ban, KA, Minei, JP, Laronga, C, et al. Executive summary of the American College of Surgeons surgical infection society surgical site infection guidelines—2016 Update. Surg Infect (Larchmt) 2017;18:379382.CrossRefGoogle ScholarPubMed
Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Platt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9:196203.CrossRefGoogle ScholarPubMed
Rao, SB, Vasquez, G, Harrop, J, et al. Risk factors for surgical site infections following spinal fusion procedures: a case-control study. Clin Infect Dis. 2011;53(7):686692.CrossRefGoogle ScholarPubMed
Data summary of HAIs in the US: assessing progress 2006–2016. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhai%2Fsurveillance%2Fdata-reports%2Fdata-summary-assessing-progress.html. Published 2018. Accessed May 13, 2019.Google Scholar
Anderson, DJ, Kaye, KS. Staphylococcal surgical site infections. Infect Dis Clin North Am 2009;23:5372.CrossRefGoogle ScholarPubMed
Lake, JG, Weiner, LM, Milstone, AM, Saiman, L, Magill, SS, See, I. Pathogen distribution and antimicrobial resistance among pediatric healthcare-associated infections reported to the National Healthcare Safety Network, 2011–2014. Infect Control Hosp Epidemiol 2018;39:111.CrossRefGoogle Scholar
Magill, SS, O’Leary, E, Janelle, SJ, Thompson, DL. Changes in prevalence of health care-associated infections in US hospitals. N Engl J Med 2018;379:17321744.CrossRefGoogle Scholar
Bruny, JL, Hall, BL, Barnhart, DC, et al. American College of Surgeons National Surgical Quality Improvement Program Pediatric: a beta phase report. J Pediatr Surg 2013;48:7480.CrossRefGoogle ScholarPubMed
Siegel, J. Pediatric infection prevention and control. In: Principles and Practice of Pediatric Infectious , vol 4, 4 th ed. Philadelphia, PA: Elsevier Health Sciences; 2012.Google Scholar
Patient safety atlas: healthcare-associated infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/portal/patient-safety-atlas.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhai%2Fsurveillance%2Far-patient-safety-atlas.html. Published 2019. Accessed May 9, 2019.Google Scholar
Steiner, CA, Karaca, Z, Moore, BJ, Imshaug, MC, Pickens, G. Surgeries in hospital-based ambulatory surgery and hospital inpatient settings. HCUP surgical brief no. 223. Agency for Healthcare Research and Quality website. www.hcup-us.ahrq.gov/reports/statbriefs/sb223-Ambulatory-Inpatient-Surgeries-2014.pdf. Published 2014. Accessed May 9, 2019.Google Scholar
Bucher, BT, Guth, RM, Elward, AM, et al. Risk factors and outcomes of surgical site infection in children. J Am Coll Surg 2011;212:10331038.CrossRefGoogle ScholarPubMed
Alten, JA, Rahman, A, Zaccagni, HJ, et al. The epidemiology of healthcare-associated infections in pediatric cardiac intensive care units. Pediatr Infect Dis J 2018;37:768772.CrossRefGoogle ScholarPubMed
Campbell, E, Beez, T, Todd, L. Prospective review of 30-day morbidity and mortality in a paediatric neurosurgical unit. Childs Nerv Syst 2017;33:483489.CrossRefGoogle Scholar
Caruso, TJ, Wang, EY, Schwenk, H, et al. A postoperative care bundle reduces surgical site infections in pediatric patients undergoing cardiac surgeries. Jt Comm J Qual Patient Saf 2019;45:156163.Google ScholarPubMed
Davis, WT, Gilbert, SR. Comparison of methicillin-resistant versus susceptible Staphylococcus aureus pediatric osteomyelitis. J Pediatr Orthop 2018;38:e285e291.CrossRefGoogle ScholarPubMed
Ellett, J, Prasad, MM, Purves, JT, Stec, AA. Postsurgical infections and perioperative antibiotics usage in pediatric genitourinary procedures. J Pediatr Urol 2015;11:e351e356.CrossRefGoogle Scholar
Feng, C, Sidhwa, F, Cameron, DB, Glass, C, Rangel, SJ. Rates and burden of surgical site infections associated with pediatric colorectal surgery: insight from the National Surgery Quality Improvement Program. J Pediatr Surg 2016;51:970974.CrossRefGoogle ScholarPubMed
Floccari, LV, Milbrandt, TA. Surgical site infections after pediatric spine surgery. Orthop Clin N Am 2016;47:387394.CrossRefGoogle ScholarPubMed
Lamberet, A, Violas, P, Buffet-Bataillon, S, et al. Postoperative spinal implant infections in children: risk factors, characteristics and outcome. Pediatr Infect Dis J 2018;37:511513.CrossRefGoogle ScholarPubMed
Mackenzie, WG, Matsumoto, H, Williams, BA, et al. Surgical site infection following spinal instrumentation for scoliosis: a multicenter analysis of rates, risk factors, and pathogens. J Bone Joint Surg Am 2013;95:800806.CrossRefGoogle ScholarPubMed
Nordin, AB, Sales, SP, Besner, GE, Levitt, MA, Wood, RJ, Kenney, BD. Effective methods to decrease surgical site infections in pediatric gastrointestinal surgery. J Pediatr Surg 2017. doi: 10.1016/j.jpedsurg.2017.10.018.Google ScholarPubMed
Shah, RK, Stey, AM, Jatana, KR, Rangel, SJ, Boss, EF. Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology. JAMA Otolaryngol Head Neck Surg 2014;140:10191026.CrossRefGoogle ScholarPubMed
Sherrod, BA, Arynchyna, AA, Johnston, JM, et al. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience. J Neurosurg Pediatr 2017;19:407420.CrossRefGoogle ScholarPubMed
Sochet, AA, Cartron, AM, Nyhan, A, et al. Surgical site infection after pediatric cardiothoracic surgery. World J Pediatr Congenit Heart Surg 2017;8:712.CrossRefGoogle ScholarPubMed
Tweddell, S, Loomba, RS, Cooper, DS, Benscoter, AL. Health care-associated infections are associated with increased length of stay and cost but not mortality in children undergoing cardiac surgery. Congenit Heart Dis 2019;14:785790.CrossRefGoogle Scholar
Warner, SJ, Uppstrom, TJ, Miller, AO, et al. Epidemiology of deep surgical site infections after pediatric spinal fusion surgery. Spine (Phila Pa 1976). 2017;42:E163E168.CrossRefGoogle ScholarPubMed
Premier Applied Sciences. Premier Healthcare database white paper: data that informs and performs. Premier Inc website. https://products.premierinc.com/downloads/PremierHealthcareDatabaseWhitepaper.pdf. Published 2018. Updated July 29, 2018. Accessed May 13, 2019.Google Scholar
Feudtner, C, Feinstein, JA, Zhong, W, Hall, M, Dai, D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014;14:199.Google ScholarPubMed
NHSN operative procedure category mappings to ICD-9-CM codes and CPT codes. Centers for Disease Control and Prevention website. https://nhsn.cdc.gov/nhsntraining/courses/2015/C08/page4045.html. Published 2015. Accessed May 13, 2019.Google Scholar
National Healthcare Safety Network (NHSN). Patient safety component manual. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/validation/2018/pcsmanual_2018-508.pdf. Published 2018. Accessed September 20, 2019.Google Scholar
Dreyfus, J, Yu, H, Begier, E, Gayle, J, Olsen, MA. Incidence of Staphylococcus aureus infections after elective surgeries in US Hospitals. Clin Infect Dis 2021;73:e2635e2646.CrossRefGoogle ScholarPubMed
HCUPnet: free healthcare statistics. Agency for Healthcare Research and Quality website. https://hcupnet.ahrq.gov/#setup. Published 2019. Accessed June 25, 2019.Google Scholar
Vegunta, RK, Gray, B, Wallace, LJ, et al. A prospective study of methicillin-resistant Staphylococcus aureus colonization in children scheduled for elective surgery. J Pediatr Surg 2009;44:11971200.Google ScholarPubMed
Schaffzin, JK, Harte, L, Marquette, S, et al. Surgical site infection reduction by the solutions for patient safety hospital engagement network. Pediatrics 2015;136:e1353e1360.CrossRefGoogle ScholarPubMed
Allpress, AL, Rosenthal, GL, Goodrich, KM, Lupinetti, FM, Zerr, DM. Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J 2004;23:231234.CrossRefGoogle ScholarPubMed
Ben-Ami, E, Levy, I, Katz, J, Dagan, O, Shalit, I. Risk factors for sternal wound infection in children undergoing cardiac surgery: a case-control study. J Hosp Infect 2008;70:335340.CrossRefGoogle ScholarPubMed
Mehta, PA, Cunningham, CK, Colella, CB, Alferis, G, Weiner, LB. Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. Pediatr Infect Dis J 2000;19:10001004.CrossRefGoogle ScholarPubMed
Cahill, PJ, Warnick, DE, Lee, MJ, et al. Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine (Phila PA 1976) 2010;35:12111217.CrossRefGoogle ScholarPubMed
Linam, WM, Margolis, PA, Staat, MA, et al. Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure. Infect Control Hosp Epidemiol 2009;30:109116.CrossRefGoogle ScholarPubMed
Rinke, ML, Jan, D, Nassim, J, Choi, J, Choi, SJ. Surgical site infections following pediatric ambulatory surgery: an epidemiologic analysis. Infect Control Hosp Epidemiol 2016;37:931938.Google ScholarPubMed
Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250278.CrossRefGoogle ScholarPubMed
Oestergaard, LB, Schmiegelow, MDS, Bruun, NE, et al. Staphylococcus aureus bacteremia in children aged 5–18 years—risk factors in the new millennium. J Pediatr 2018;203:108115.CrossRefGoogle ScholarPubMed
Korol, E, Johnston, K, Waser, N, et al. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS One 2013;8:e83743.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network. Procedure associated module: surgical site infection (SSI) event Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Published 2020. Accessed February 18, 2020.Google Scholar
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