Surgery-Associated Infections among Infants Born Extremely Preterm

Abstract

To assess the burden of invasive infection following surgery (surgery-associated infections [SAI]) among infants born extremely premature. This was an observational, prospective study of infants born at gestational age 22-28weeks hospitalized for >3days, 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 ≤14days following a surgical procedure. 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 ≤14days 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 ≤14days after surgery occurred in 141 of the 1154 infants; 128 deaths occurred after gastrointestinal surgeries. 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.