Postoperative Wound Infection in a Pediatric Surgical Service By Lalit K. Sharma and P.K. Sharma Rohtak, India 9 Seventy-two out of 1,325 consecutive pediatric patients (5.43%) developed an operative wound infection in a general pediatric surgery unit. The wound infection rate was observed to be highest in neonates (13.75%) as compared with the children over 5 years of age (2.93%). The increased susceptibility of newborns to wound infec- tion was found to be statistically significant. Patients operated for gastrointestinal problems and solid abdominal neoplasms had the highest wound infection rate. 9 1986 by Grune & Stratton, Inc. INDEX WORDS: Postoperative wound infection. T HE DEVELOPMENT of postoperative wound infection is an important event that can not always be prevented. The economic, physical, and psychological impact of postoperative wound sepsis mandates the recognition of the problem and enuncia- tion of the use of preventive measures. ~ The present day literature is replete with recognition of this prob- lem in almost all surgical specialties dealing with the adult patient population and identification of high risk patients among this age group. 2 The problem of wound infection in general pediatric surgery remains to be identified and analyzed as only two reports, one each in English 3 and Spanish, 4 have so far been published. The study presented here is an attempt to identify the extent of postoperative wound infection in a general pediatric surgical unit in northwest India. An endeavor has been made to identify the high risk patients for this complication with relation to age, sex, and organ systems involved in the surgical procedure. coccus pyogenous, either as the single isolate or in mixed organisms, was isolated in highest number of cultures (36%). The microbiology of the isolated pus is outlined in Table 2. RESULTS The overall surgical wound infection rate was 72/ 1,325 (5.43%). The development of wound infection was not influenced by the sex of the patient operated (M:F ratio 61:11 or 5.5:1) with wound sepsis ratio of 4.9:1. Statistical analysis (P.K.S.) of the different age groups shown in Table 1 was done by chi square test. 6 The null hypothesis taken for the analysis was that operative wound infection is independent of age. On analysis this hypothesis is rejected (degree of freedom [DF] = 3, X 2 = 28.4670, P < .001). In order to compare the infection rate among various age groups (neonatal, infants, preschool, and school age), the wound infection rates were compared (Table 3). There was a statistically significant higher chance of opera- tive wound infection if the patient was less than 28 days of age as compared with the one above 5 years. The chances of wound sepsis diminish with advancing age, being minimal in children aged 5 years and above. The highest rate of wound infection was observed in patients undergoing surgery for solid malignant tumors concomitantly with chemotherapy and radio- therapy (18.75%). This was followed by patients undergoing colonic surgery (12.39%). The lowest rate was seen in patients with uncomplicated hernia repair (Fig 1). MATERIALS AND METHODS All patients undergoing surgical procedures in the pediatric surgical service were classified according to age, sex, and the type of operative procedure performed: clean, clean contaminated, contami- nated, and dirty. 5 The latter two categories were combined in the analysis due to relatively smaller numbers and statistical facilitation. A surgical wound was categorized infected in the presence of frank pus developing up to 4 weeks after the surgical procedure.5 Erythema at the suture line, seroma in the subcutaneous tissue, and minor stitch abscess not leading to development of frank pus were not included in this study. Patients not followed for 4 weeks postsurgery, dying within this period, and leaving the hospital against medical advice have been excluded. The study comprises 1,325 consecutive patients of whom 1,103 were males and 222 females (sex ratio 4.9:1). Seventy-two patients developed frank pus in their surgical wounds. The incidence of wound infection, stratified into various age groups and types of surgical wounds, is depicted in Table 1. On bacteriologic analysis of pus, no organisms were isolated in four instances. No anerobes or faculative anerobes were grown in any of the specimens. Staphylo- DISCUSSION There are three basic factors for consideration in the epidemiology of postoperative wound infection: the degree of microbial contamination at time of surgery, host resistence, and the condition of the wound. 2 The first of these, the degree of microbial contamination, can be reduced if not entirely eliminated. The last, condition of the wound; clean, elective, or traumatic can not always be controlled. For the second factor the host needs to be individualized. A critical analysis of From the Department of Pediatric Surgery, Medical College Hospital, Rohtak, India. Address reprint requests to Lalit K. Sharma, FRCS, 5-9J, Medical Enclave, Rohtak, Haryana, 124001 India. 9 1986 by Grune & Stratton, Inc. 0022-3468/86/2 l 10~9015503.00/0 Journal of Pediatric Surgery, Vol 21, No 10 (October), 1986: pp 889-891 889