Objective

To assess the burden of invasive infection following surgery (surgery-associated infections [SAI]) among infants born extremely premature.

Study design

This was an observational, prospective study of infants born at gestational age 22-28 weeks hospitalized for >3 days, between April 1, 2011, to March 31, 2015, in academic centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. SAI was defined by culture-confirmed bacteremia, fungemia, or meningitis ≤14 days following a surgical procedure.

Results

Of 6573 infants, 1154 (18%) who underwent surgery were of lower gestational age (mean [SD]: 25.5 [1.6] vs 26.2 [1.6], P < .001), lower birth weight (803 [220] vs 886 [244], P < .001), and more likely to have a major birth defect (10% vs 3%, P < .001); 64% had 1 surgery (range 1-10 per infant). Most underwent gastrointestinal procedures (873, 76%) followed by central nervous system procedures (150, 13%). Eighty-five (7%) infants had 90 SAIs (78 bacteremia, 5 fungemia, 1 bacteremia and meningitis, 6 meningitis alone). Coagulase-negative staphylococci were isolated in 36 (40%) SAI and were isolated with another organism in 5 episodes. Risk of SAI or death ≤14 days after surgery was greater after gastrointestinal compared with central nervous system procedures (16% vs 7%, adjusted relative risk [95% CI]: 1.95 [1.15-3.29], P = .01). Death ≤14 days after surgery occurred in 141 of the 1154 infants; 128 deaths occurred after gastrointestinal surgeries.

Conclusions

Surgical procedures were associated with bacteremia, fungemia, or meningitis in 7% of infants. The epidemiology of invasive postoperative infections as described in this report may inform the selection of empiric antimicrobial therapy and postoperative preventive care.

中文翻译：

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极早产儿的手术相关感染

客观的

评估极早产儿手术后侵入性感染的负担（手术相关感染 [SAI]）。

学习规划

这是一项观察性、前瞻性研究，对象为 2011 年 4 月 1 日至 2015 年 3 月 31 日期间在Eunice Kennedy Shriver国家儿童健康与人类研究所学术中心住院超过 3 天的胎龄 22-28 周出生的婴儿发展新生儿研究网络。SAI 定义为手术后 ≤ 14 天经培养证实的菌血症、真菌血症或脑膜炎。

结果

在 6573 名婴儿中，接受手术的 1154 名 (18%) 胎龄较低（平均 [SD]：25.5 [1.6] vs 26.2 [1.6]，P  < .001），出生体重较低（803 [220] vs 886 [ 244], P  < .001), 并且更可能有重大出生缺陷 (10% 对 3%, P < .001); 64% 进行了 1 次手术（范围为每个婴儿 1-10 次）。大多数人接受了胃肠道手术 (873, 76%)，其次是中枢神经系统手术 (150, 13%)。85 名 (7%) 婴儿有 90 次 SAI（78 次菌血症、5 次真菌血症、1 次菌血症和脑膜炎、6 次单纯脑膜炎）。在 36 例 (40%) SAI 中分离出凝固酶阴性葡萄球菌，并在 5 次事件中分离出另一种生物体。与中枢神经系统手术相比，胃肠道手术后 SAI 或手术后 ≤ 14 天死亡的风险更高（16% 对 7%，调整后的相对风险 [95% CI]：1.95 [1.15-3.29]，P  = .01）。1154 名婴儿中有 141 名在术后 14 天内死亡；胃肠道手术后有 128 人死亡。

结论

在 7% 的婴儿中，外科手术与菌血症、真菌血症或脑膜炎有关。本报告中描述的侵入性术后感染的流行病学可为经验性抗菌治疗和术后预防性护理的选择提供信息。