Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants

Abstract

Background Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved. Methods Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures. Results The 141 included infants underwent surgery at a median age of 10 months (range: 1–24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4–30). The most common microbes discovered were skin bacteria Staphylococcus aureus or Streptococcus pyogenes, but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis. Conclusion Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.

Is endoscopy beneficial in pediatric laparoscopic gastrostomy insertion; A 9-year comparative study

“…In total, 24 (13 LAG and 11 LAPEG) patients had surgical site infection requiring treatment with oral antibiotics. Surgical site infection was identified as erythema, induration, exudate, or purulent secretion at the surgical gastrostomy site within 30 days of the procedure ( 6 ). A wound culture was obtained any time considered necessary and treatment with antibiotics was prescribed when considered indicated, which was at the surgeon or gastroenterologists’ discretion.…”

“…Gastrostomy tube insertion is a well-established procedure for pediatric patients which can be placed using various techniques. Gastrostomy insertion is indicated when patients have insufficient nutritional or medical intake for a period of >2–3 weeks, or when the need for additional enteral feeding (e.g., through a nasogastric tube) is expected to exceed >3 months ( 6 ). Our patients had a variety of medical diseases requiring prolonged enteral tube feeding or specialized feeds for metabolic disorders.…”

“…Re-intervention under anesthesia was defined as any procedure undertaken under general anesthesia that was performed in relation to a gastrostomy related complication within the first 6 weeks of insertion. Surgical site infection was identified as erythema, induration, exudate, or purulent secretion at the surgical gastrostomy site within 30 days of the procedure ( 6 ). A wound culture was obtained any time considered necessary and treatment with antibiotics was prescribed when considered indicated, which was at the surgeon or gastroenterologists’ discretion.…”

Incidence and Relative Burden of Surgical Site Infections in Children Undergoing Nonemergent Surgery

“…These relatively high OSI rates may be reflective of the challenging nature of esophageal anastomoses in many cases, with reported leak rates as high as 23% 17 . While relatively high SSI rates have been previously reported for colorectal procedures and gastrostomy, SSI rates associated with gastrostomy closure and small bowel procedures in the pediatric population have not been well characterized 10,18–22 . The finding that incisional SSI rates were higher following small bowel and gastrostomy closure procedures than for colorectal procedures was another surprising finding, and one where data appear to differ between the adult and pediatric surgical populations 20–22 .…”

“…17 While relatively high SSI rates have been previously reported for colorectal procedures and gastrostomy, SSI rates associated with gastrostomy closure and small bowel procedures in the pediatric population have not been well characterized. 10,[18][19][20][21][22] The finding that incisional SSI rates were higher following small bowel and gastrostomy closure procedures than for colorectal procedures was another surprising finding, and one where data appear to differ between the adult and pediatric surgical populations. [20][21][22] It is important to emphasize that the high rate of SSI associated with gastrostomy procedures (both creation and closure) may be influenced by difficulty in differentiating SSI from wound erythema during the postoperative period.…”