Análise Das Infecções De Sítio Cirúrgico Em Pacientes Pediátricos Após Cirurgia Ortopédica: Um Estudo Caso-Controle

Abstract

Objectives: To describe the rate of surgical site infections in children undergoing orthopedic surgery in centers of excellence and analyze the patients’ profiles. Methods: Medical records of pediatric patients undergoing orthopedic surgery in the Jamil Haddad National Institute of Traumatology and Orthopedics from January 2012 to December 2013 were analyzed and monitored for one year. Patients diagnosed with surgical site infection were matched with patients without infection by age, date of admission, field of orthopedic surgery and type of surgical procedure. Patient, surgical and follow-up variables were examined. Descriptive, bivariate and correspondence analyses were performed to evaluate the patients’ profiles. Results: 347 surgeries and 10 surgical site infections (2.88%) were identified. There was association of infections with age - odds ratio (OR) 11.5 (confidence interval - 95%CI 1.41-94.9) -, implant - OR 7.3 (95%CI 1.46-36.3) -, preoperative period - OR 9.8 (95%CI 1.83-53.0), and length of hospitalization - OR 20.6 (95%CI 3.7-114.2). The correspondence analysis correlated the infection and preoperative period, weight, weight Z-score, age, implant, type of surgical procedure, and length of hospitalization. Average time to diagnosis of infection occurred 26.5±111.46 days after surgery. Conclusions: The rate of surgical site infection was 2.88%, while higher in children over 24 months of age who underwent surgical implant procedures and had longer preoperative periods and lengths of hospitalization. This study identified variables for the epidemiological surveillance of these events in children. Available databases and appropriate analysis methods are essential to monitor and improve the quality of care offered to the pediatric population.

Untitled

“…In a cross-sectional study, 20 obesity was, among other chronic diseases, a risk factor for the development of SSI in 9.5% of patients undergoing surgery. Another study published in 2017, 21 which aimed to assess risk factors for SSI, also showed a significant frequency of 21% of patients with obesity. In another cohort study with patients who underwent bariatric surgery, it was identified that there is a proportionality between the increase in the body mass index (BMI) range and the incidence of SSI cases.…”

“…One of the selected articles pointed out the use of implants as one of the factors that predisposes to the occurrence of SSI, mainly related to the formation of biofilms on the implant surface, which can interfere with the patient's immunological defense and the effectiveness of antibiotic therapy. 21 In addition , the bacteria that make up biofilms have the possibility of sharing genetic materials through conjugation, a worrying factor in the hospital environment as it facilitates the exchange of bacterial resistance genes, reducing the antimicrobial alternatives for treating SSI. 26,27 Immunosuppressants are drugs that act by inhibiting cell division and decreasing the inflammatory process, they are indicated to prevent rejection of transplanted organs and to treat inflammatory diseases.…”

Fatores de risco para infecção de sítio cirúrgico em cirurgias traumato-ortopédicas

“…Dessa forma, a literatura aponta que os principais fatores de risco para ISC em cirurgias ortopédicas são: a condição clínica do paciente 5,7 ; diabetes mellitus, obesidade, idade 6,[8][9] , internação pré-operatória prolongada 5,9 , antissepsia da pele; técnica de degermação e uso de Equipamentos de Proteção Individual (EPI's) pela equipe 7,10 e duração da cirurgia [8][9][10] .…”

Utilização Do Protocolo Sepse Numa Unidade De Urgência E Emergência: Relato De Experiência

“…Ë importante que se tenha um controle destas ISCs sendo um importante indicador de vigilância dos pacientes cirúrgicos tanto para a gestão quanto para a assistência. O acompanhamento sistemático da sua prevalência possibilita o planejamento de ações preventivas e a elaboração de estratégias de controle dessas infecções (CHAGAS et al, 2017).…”