pmjТихоокеанский медицинский журналPacific Medical Journal1609-1175TGMU10.17238/PmJ1609-1175.2018.3.61-63pmj-260Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHESФакторы риска развития инфекций в области хирургического вмешательства в детской хирургииRISK FACTORS FOR SURGICAL SITE INFECTION IN PEDIATRIC SURGERYМалашенкоА. А.MalashenkoA. A.nastena7887@mail.ruАслановБ. И.AslanovB. I.noemail@neicon.ruНабиеваА. С.NabievaA. S.noemail@neicon.ruЭбертМ. А.YebertM. A.noemail@neicon.ruКолосовскаяЕ. Н.KolosovckayaE. N.noemail@neicon.ruСеверо-Западный мед. университет им. И.И. Мечникова; Детская городская больница № 19 им. К.А. РаухфусаРоссияNorth-Western State Medical University named after I.I. Mechnikov; Rauhfus Childrens City Hospital No. 19Russian FederationСеверо-Западный мед. университет им. И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian FederationСанкт-Петербургский педиатрический медицинский университетРоссияSt. Petersburg Pediatric Medical UniversityRussian FederationВоенно-медицинская академия им. С.М. КироваРоссияMilitary Medical Academy named after S.M. KirovRussian Federation201828092018036163Copyright © Малашенко А.А., Асланов Б.И., Набиева А.С., Эберт М.А., Колосовская Е.Н., 20182018Малашенко А.А., Асланов Б.И., Набиева А.С., Эберт М.А., Колосовская Е.Н.Malashenko A.A., Aslanov B.I., Nabieva A.S., Yebert M.A., Kolosovckaya E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tmj-vgmu.ru/jour/article/view/260

Одной из ведущих форм инфекций, связанных с оказанием медицинской помощи, развивающихся в послеоперационном периоде, в том числе в детской хирургии, служат инфекции в области хирургического вмешательства. Несмотря на многочисленные исследования по оценке факторов риска у взрослой популяции, этот вопрос в детской хирургии остается недостаточно изученным. Выявленная в настоящей работе структура факторов риска госпитальных инфекций в детском хирургическом стационаре отличалась от взрослой клиники преобладанием «внешних» факторов, связанных с хирургическим вмешательством, и меньшей ролью «внутренних» факторов, зависящих от состояния пациента. Такое соотношение факторов риска требует внимания и обязательного учета при разработке профилактических и противоэпидемических мероприятий в детской хирургии.

Objective. Information on risk factors for the development of surgical site infections (SSI) is the basis of preventive measures. However, the currently known risk factors are well studied mainly in populations of adult patients, while there is very little data on the predictors of SSI in pediatric surgery. In particular, there is insufficient data on "external" factors, associated with surgical intervention, and "internal" factors, associated with the patient>s condition, their correlation and significance in the development of SSI in pediatric surgery. Methods. The study was conducted in the Pediatric City Hospital No. 19. Three surgical departments were involved in the study: traumatology, surgical department and neurosurgery. The subject of the study were patients and medical records. The significance of "external" and "internal" risk factors for SSI was assessed during the study. 1246 patients from pediatric surgery departments participated in the study in the period from 2015-2017. SSI was detected using standard case definitions. For a number of risk factors with dichotomous characteristics a case-control study was conducted. Results. A significantly higher incidence of SSI was observed in a group of patients who had the wound class of 3 or more. When assessing the likelihood of development of SSI depending on the integral index of NNIS, it was revealed that the highest risk was observed with the NNIS index of 3 - 71.4 per 100 operations. The incidence of infection increased proportionally with the index: NNIS 0 - 3.0, NNIS 1 - 33.4, NNIS 2 - 28.6 per 100 surgical interventions. The odds ratio (ОШ) with confidence intervals for the urgency of the operation was 6.7, for drainage - 1.6, for the duration of surgery - 2.2. Such factors as the type of anesthesia, shaving, blood transfusion and the number of operations performed simultaneously were not significant in the development of SSI in the pediatric patient population. Evaluating the effect of "internal" risk factors for SSI has shown that among all the predictors studied only co-morbidities significantly increased the risk of SSI in children. Other risk factors for SSI that are significant in the adult population of surgical patients (age, obesity, length of hospital stay) did not contribute to an increase in the likelihood of SSI in pediatric surgery. Conclusions. It was revealed that the "external" factors associated with surgical interventions predominate in the structure of risk factors of SSI in pediatric surgery: type of operation, class of the surgical wound, urgency of the operation, drainage, duration of the operation. Among the "internal" factors associated with the patient>s condition only the presence of concomitant diseases is important.

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The authors declare that there are no conflicts of interest present.