BMJ Global Health (Dec 2020)

Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study

  • ,
  • Sèbastien Gaujoux,
  • Nebyou Seyoum,
  • Ville Sallinen,
  • Ari Leppäniemi,
  • Andrea Belli,
  • Clare Skerritt,
  • Naomi Wright,
  • Savva Pronin,
  • Azmina Verjee,
  • Thomas Pinkney,
  • Neil Smart,
  • Oliver Warren,
  • Michele Sacco,
  • Arnav Agarwal,
  • Simon Paterson-Brown,
  • David Evans,
  • Philip Choi,
  • Ashish Gupta,
  • Jonathan Myers,
  • Victor Kong,
  • Michael Wilson,
  • Ewen M Harrison,
  • Mircea Beuran,
  • Ionut Negoi,
  • Zahra Jaffry,
  • Leonardo Solaini,
  • Thomas M Drake,
  • Dmitri Nepogodiev,
  • Adesoji O Ademuyiwa,
  • Philip Alexander,
  • Sara W Al-Saqqa,
  • Sule Burger,
  • Kathryn Chu,
  • Dhruv Ghosh,
  • Hosni Khairy Salem,
  • Marie Carmela Lapitan,
  • Ismail Lawani,
  • Maria Lorena Aguilera,
  • Mayaba Maimbo,
  • Alex Makupe,
  • Rachel Moore,
  • Vanessa Msosa,
  • Alphonse Zeta Mutabazi,
  • Riinu Ots,
  • Ahmad Uzair Qureshi,
  • Sarah Rayne,
  • Marie Dione Parreno-Sacdalan,
  • Richard Spence,
  • Stephen Tabiri,
  • Richard Lilford,
  • Dion Morton,
  • Aneel Bhangu,
  • Tom Abbott,
  • Gehad Tawfik,
  • Sebastian King,
  • Alexia Farrugia,
  • Jay Park,
  • Abhishek Sharma,
  • Augusto Zani,
  • Christopher Smith,
  • Jonathan Lund,
  • Stefano Giuliani,
  • John Whitaker,
  • Elaine Borg,
  • Alexis Arnaud,
  • Esther Ferrero,
  • Andrea Ruzzenente,
  • Jennifer Rickard,
  • Yousef Abuowda,
  • Enas Alaloul,
  • Natalie Blencowe,
  • Sanjay Patel,
  • Mark Ian Hampton,
  • Ewen Griffiths,
  • André L Mihaljevic,
  • Elizabeth Evans,
  • Catherine A Shaw,
  • Jennifer Ploski,
  • Mengistu Worku,
  • Ashish Minocha,
  • Shiva Dindyal,
  • Midhun Mohan,
  • Dina Fouad,
  • Christopher Owen,
  • Priya Patel,
  • Sunil Kumar,
  • James Yang,
  • Kevin C Conlon,
  • Sandro Pasquali,
  • Mohamed Mostafa,
  • Yoshan Moodley,
  • Kathryn Lee,
  • James Glasbey,
  • Gareth Irwin,
  • Kjetil Søreide,
  • Catrin Morgan,
  • Ruth Blanco-Colino,
  • Francesco Pata,
  • Gianluca Pellino,
  • Sivesh K Kamarajah,
  • Luke Nicholson,
  • Adesoji Ademuyiwa,
  • Felix Alakaloko,
  • Olumide Elebute,
  • Omolara Faboya,
  • Taiwo Lawal,
  • Omolara Williams,
  • Andrey Litvin,
  • Elodie Haraux,
  • James Olivier,
  • Michael Stoddart,
  • Rebecca White,
  • George Ihediwa,
  • Luigi Bonavina,
  • Chetan Khatri,
  • Stephen O'Neill,
  • Roger Schmid,
  • Stephen Knight,
  • Ahmed Soliman,
  • Carly Bisset,
  • Robert Parker,
  • Rakan Kabariti,
  • Joshua Luck,
  • Guo Liang Yong,
  • Tanzeela Gala,
  • David Bunting,
  • Lydia Longstaff,
  • Ye Ru Chin,
  • J Edward Fitzgerald,
  • Giuliano Borda-Luque,
  • Ainhoa Costas-Chavarri,
  • Faustin Ntirenganya,
  • Stuart J Fergusson,
  • JC Allen Ingabire,
  • Lawani Ismaïl,
  • Anyomih Theophilus Teddy Kojo,
  • Adewale O Adisa,
  • Tomas Poškus,
  • Antonio Ramos-De la Medina,
  • Sebastian Shu,
  • Emmy Runigamugabo,
  • Afnan Altamini,
  • Andrew Kirby,
  • Gustavo Recinos,
  • Jen Cornick,
  • Maria Marta Modolo,
  • Sayeda Nazmum Nahar,
  • Ade Waterman,
  • Ismail Lawini,
  • Mohammed Firdouse,
  • Tyler Rouse,
  • Qinyang Liu,
  • Juan Camilo Correa,
  • Peep Talving,
  • Dushyant Iyer,
  • Tom Arthur,
  • MariaLorena Aguilera,
  • Basant Kumar,
  • Radhian Amandito,
  • Roy Quek,
  • Luca Ansaloni,
  • Ahmed Altibi,
  • Donatas Venskutonis,
  • Justas Zilinskas,
  • YongYong Tew,
  • Ramos-DelaMedina Antonio,
  • Zineb Bent,
  • Ibrahim Al-Slaibi,
  • Haya Tahboub,
  • Osaid H Alser,
  • Diego Romani,
  • Sebestian Shu,
  • Piotr Major,
  • Aurel Mironescu,
  • Matei Bratu,
  • Amar Kourdouli,
  • Saint Kitts,
  • Mohammed Ubaid Alsaggaf,
  • Ahmad Gudal,
  • Al Faifi Jubran,
  • Sierra Leone,
  • Sam Seisay,
  • Bettina Lieske,
  • Irene Ortega,
  • Jenifa Jeyakumar,
  • Kithsiri Senanayake,
  • Omar Abdulbagi,
  • Yucel Cengiz,
  • Dmitri Raptis,
  • Yuksel Altinel,
  • Chia Kong,
  • Ella Teasdale,
  • Sukrit Suresh,
  • Katherine Gash,
  • Mark Scott,
  • Ragavan Narayanan,
  • Besmir Grizhja,
  • Shpetim Ymeri,
  • Gezim Galiqi,
  • Roberto Klappenbach,
  • Diego Antezana,
  • Alvaro Enrique MendozaBeleño,
  • Cecilia Costa,
  • Belen Sanchez,
  • Susan Aviles,
  • Claudio Gabriel Fermani,
  • Rubén Balmaceda,
  • Santiago Villalobos,
  • Juan Manuel Carmona,
  • Daniel Hamill,
  • Peter Deutschmann,
  • Simone Sandler,
  • Daniel Cox,
  • Ram Nataraja,
  • Claire Sharpin,
  • Damir Ljuhar,
  • Demi Gray,
  • Morgan Haines,
  • Dush Iyer,
  • Nithya Niranjan,
  • Scott D'Amours,
  • Morvarid Ashtari,
  • Helena Franco,
  • Ashrarur Rahman Mitul,
  • Sabbir Karim,
  • Nowrin F Aman,
  • Mahnuma Mahfuz Estee,
  • Umme Salma,
  • Joyeta Razzaque,
  • Tasnia Hamidkanta,
  • Sayeedaaktar Tori,
  • Md Shadid Alamin,
  • Swapnil Roy,
  • Md Shadid Al Amin,
  • Muhtarima Haque,
  • Amreen Faruq,
  • Farhana Iftekhar Margaret,
  • Greg Padmore O'Shea,
  • Ramesh Jonnalagadda,
  • Aliaksandr Filatau,
  • Dzmitry Paulouski,
  • Maryna Shubianok,
  • Tatsiana Shachykava,
  • Dzianis Khokha,
  • Vladimir Khokha,
  • Fernande Djivoh,
  • Francis Dossou,
  • Djifid Morel Seto,
  • Dansou Gaspard Gbessi,
  • Bruno Noukpozounkou,
  • Yacoubou Imorou Souaibou,
  • Kpèmahouton René Keke,
  • Fred Hodonou,
  • Ernestyemalinstephane Ahounou,
  • Thierry Alihonou,
  • Max Dénakpo,
  • Germain Ahlonsou,
  • Alemayehu Ginbo Bedada,
  • Carlos Nsengiyumva,
  • Sandrine Kwizera,
  • Venerand Barendegere,
  • Simon Stock,
  • Luai Jamal,
  • Georges Azzie,
  • Sameer Kushwaha,
  • Tzu-Ling Chen,
  • Chingwan Yip,
  • Irene Montes,
  • Felipe Zapata,
  • Sebastian Sierra,
  • Mohamed Youssef,
  • Hossam Elfeki,
  • Waleed Thabet,
  • Aly Sanad,
  • Ahmed Zaki,
  • Noran Abdel-Hameed,
  • Esraa Abd Elkhalek,
  • Yehia Zakaria,
  • Tarek Ezzat,
  • Ali Abo ElDahab,
  • Mohamed Kelany,
  • Sara Arafa,
  • OsamaMokhtar Mohamed Hassan,
  • Nermin Mohamed Badwi,
  • Ahmad Saber Sleem,
  • Hussien Ahmed,
  • Kholoud Abdelbadeai,
  • Mohamed Abozed Abdullah,
  • Muhammadamsyarauni Lokman,
  • Suraya Bahar,
  • Anan Radyabdelazeam,
  • Abdelrahman Adelshone,
  • Muhammad Bin Hasnan,
  • Athirah Zulkifli,
  • Siti NurAlia Kamarulzamil,
  • Abdelaziz Elhendawy,
  • Aliang Latif,
  • Ahmad Bin Adnan,
  • Shahadatul Shaharuddin,
  • Aminah HanumHaji AbdulMajid,
  • Mahmoud Amreia,
  • Dina Al-Marakby,
  • Mahmoud Salma,
  • Mohamadjeffreybin Ismail,
  • Elissa Rifhan MohdBasir,
  • Citra Dewi MohdAli,
  • Aya Yehia Ata,
  • Maha Nasr,
  • Asmaa Rezq,
  • Ahmed Sheta,
  • Sherif Tariq,
  • Abdelkhalek Sallam,
  • Abdelrhman KZ Darwish,
  • Sohaila Elmihy,
  • Shady El Hadry,
  • Ahmed Farag,
  • Haidar Hajah,
  • Abdelaziz Seliem,
  • Amro Aglan,
  • Ahmed Zohair,
  • Mahitab Essam,
  • Omar Moussa,
  • Esraa El-Gizawy,
  • Mostafa Samy,
  • Safia Ali,
  • Esraa Elhalawany,
  • Ahmed Ata,
  • Mohamed Elhalawany,
  • Mohamed Nashat,
  • Samar Soliman,
  • Alaa Elazab,
  • Mostada Samy,
  • Mohamed A Abdelaziz,
  • Khaled Ibrahim,
  • Ahmed mohamed Ibrahim,
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  • Hager Abdulazizamin,
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  • Mahmoud Saami,
  • Nada Ahmedredaelsayed,
  • Adham Tarek,
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  • Islam MagdyEl Sayed,
  • Amira Reda,
  • Martina Yusufshawky,
  • Mohammed Mousasalem,
  • Shahinaz Alaa El-Din,
  • Noha Abdullah Soliman,
  • Muhammed Talaat,
  • Shahinaz Alaael-Dein AhmedAbdelmoenelhusseiny,
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  • Mohammed Elshaar,
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  • Khalid Salah El-Dien,
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  • Fahd Abdelsabour,
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  • Mahmoud M Saad,
  • Khalil Abdulbassit,
  • Nadia Khalidabdelatif,
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  • Ahmed Gad,
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  • Ahmed Abdelsameea,
  • Mohamed Hafez,
  • Ahmad Sabe,
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  • Nada Mohamed Bekheta,
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  • Mahmoud A Elnajjar,
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  • Ihab Hassan,
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  • Badreldinadel Tawfik,
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  • Mariam O Gad‏,
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  • Monica Bassem,
  • Nadia Khaledabdel-Latif,
  • Noha Maraie,
  • Nourhan Medhat Elhadary,
  • Nourhan Semeda,
  • Shaza Rabiemohamed,
  • Hesham Mohammed Bakry,
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  • Dina Tarek,
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  • Rasha Abdelhamed,
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  • Amna Mohamed,
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  • Eman Mohamed Ibrahim,
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  • Elsa Robert,
  • Betty Maillot,
  • Etienne Courboin,
  • Alexis Pierre Arnaud,
  • Juliette Hascoet,
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  • Quentin Ballouhey,
  • Céline Grosos,
  • Laurent Fourcade,
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  • Francois-Coridon Helene,
  • Xavier Delforge,
  • Bertrand Dousset,
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  • Aurore Haffreingue,
  • Julien Rod,
  • Mariette Renaux-Petel,
  • Jean-François Lecompte,
  • Jean Bréaud,
  • Pauline Gastaldi,
  • Chouikh Taieb,
  • Raquillet Claire,
  • Echaieb Anis,
  • Nasir Bustangi,
  • Manuel Lopez,
  • Aurelien Scalabre,
  • Maria Giovanna Grella,
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  • Aline Broch,
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  • Micheal Ohene-Yeboah,
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  • Jonathan Dakubo,
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  • Joachim Amoako,
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  • Ioannis Kyriazanos,
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  • Angelos Tselos,
  • Georgios Tzikos,
  • Evangelos Voulgaris,
  • Dimitrios Lytras,
  • Athanasia Bamicha,
  • Kyriakos Psarianos,
  • Anastasios Stefanopoulos,
  • Ioannis Patoulias,
  • Dimitrios Sfougaris,
  • Ioannis Valioulis,
  • Dimitrios Balalis,
  • Dimitrios Korkolis,
  • Dimitrios K Manatakis,
  • Georgios Kyrou,
  • Georgios Karabelias,
  • Iason-Antonios Papaskarlatos,
  • Kolonia Konstantina,
  • Nikolaos Zampitis,
  • Stylianos Germanos,
  • Aspasia Papailia,
  • Theodosios Theodosopoulos,
  • Georgios Gkiokas,
  • Magdalini Mitroudi,
  • Christina Panteli,
  • Thomas Feidantsis,
  • Konstantinos Farmakis,
  • Dimitrios Kyziridis,
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  • Maria-Lorena Aguilera-Arevalo,
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  • Emmanuel Barrios,
  • Servio TulioTorres Rodriguez,
  • Carlos Pazgalvez,
  • Danilo Herreracruz,
  • Guillermo Sanchez Rosenberg,
  • Alejandro Matheu,
  • David Monterroso Cohen,
  • Marie Paul,
  • Angeline Charles,
  • Justin ChakYiu Lam,
  • Man Hon AndrewYeung,
  • Chi Ying JacquelynFok,
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  • Yuk HongEric Cheung,
  • Hong Yee Wong,
  • Ka Wai Leung,
  • Tien Seng BryanLee,
  • Wai Him Lam,
  • Weihei Dao,
  • Stephanie Hiu-wai Kwok,
  • Tsz-Yan Katie Chan,
  • Yung Kok Ng,
  • Chi Chung Foo,
  • Ankur Bhatnagar,
  • Vijaid Upadhyaya,
  • Uday Muddebihal,
  • Wasim Dar,
  • Janardhan,
  • Neerav Aruldas,
  • Fidelis Jacklyn Adella,
  • Anthonius Santoso Rulie,
  • Ferdy Iskandar,
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  • Afifatun Hasanah,
  • T Ariani Widiastini,
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  • Wifantosaditya Jeo,
  • Nathania Sutandi,
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  • Phebe Anggita Gultom,
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  • Andreass Haloho,
  • Nadya Johanna,
  • Felix Lee,
  • Radin MohdNurrahman RadinDorani,
  • Martha Glynn,
  • Mohammad Alherz,
  • Wennweoi Goh,
  • Haaris A Shiwani,
  • Lorraine Sproule,
  • Miklosh Bala,
  • Asaf Kedar,
  • Luca Turati,
  • Federica Bianco,
  • Francesca Steccanella,
  • Gaetano Gallo,
  • Mario Trompetto,
  • Giuseppe Clerico,
  • Matteo Papandrea,
  • Giuseppe Sammarco,
  • Rosario Sacco,
  • Angelo Benevento,
  • Luisa Giavarini,
  • Mariano Cesare Giglio,
  • Luigi Bucci,
  • Gianluca Pagano,
  • Viviana Sollazzo,
  • Roberto Peltrini,
  • Gaetano Luglio,
  • Arianna Birindelli,
  • Salomone Di Saverio,
  • Gregorio Tugnoli,
  • Miguel Angel Paludi,
  • Pietro Mingrone,
  • Domenica Pata,
  • Francesco Selvaggi,
  • Lucio Selvaggi,
  • Natale Di Martino,
  • Gianluca Curletti,
  • Paolo Aonzo,
  • Raffaele Galleano,
  • Stefano Berti,
  • Elisa Francone,
  • Silvia Boni,
  • Laura Lorenzon,
  • Annalisa Lo Conte,
  • Genoveffa Balducci,
  • Gianmaria Confalonieri,
  • Giovanni Pesenti,
  • Laura Gavagna,
  • Giorgio Vasquez,
  • Simone Targa,
  • Savino Occhionorelli,
  • Dario Andreotti,
  • Giacomo Pata,
  • Fabrizio Aquilino,
  • Nicola Chetta,
  • Arcangelo Picciariello,
  • Mohamed Abdelkhalek,
  • Silvia De Franciscis,
  • Annamaria Bigaran,
  • Alessandro Favero,
  • Stefano MM Basso,
  • Paola Salusso,
  • Martina Perino,
  • Sylvie Mochet,
  • Diego Sasia,
  • Francesco Riente,
  • Marco Migliore,
  • David Merlini,
  • Silvia Basilicò,
  • Carlo Corbellini,
  • Veronica Lazzari,
  • Yuri Macchitella,
  • Daniele Angelieri,
  • Diego Coletta,
  • Federica Falaschi,
  • Marco Catani,
  • Claudia Reali,
  • Mariastella Malavenda,
  • Celeste Del Basso,
  • Sergio Ribaldi,
  • Massimo Coletti,
  • Andrea Natili,
  • Norma Depalma,
  • Immacolata Iannone,
  • Angelo Antoniozzi,
  • Davide Rossi,
  • Daniele Gui,
  • Gerardo Perrotta,
  • Matteo Ripa,
  • Francesco Ruben Giardino,
  • Maurizio Foco,
  • Erika Vicario,
  • Federico Coccolini,
  • Gabriela Elisa Nita,
  • Nicoletta Leone,
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  • Celeste Caliman,
  • Mieshia Beamon,
  • Therese Duane,
  • Mamta Swaroop,
  • Rebecca Deal,
  • Erik Schadde,
  • Mark Hemmila,
  • Lena Napolitano,
  • Kathleen To,
  • Joseph Musowoya,
  • Niels Van Der Naald,
  • Dayson Kumwenda,
  • Alex Reece-Smith,
  • Kars Otten,
  • Anna Verbeek,
  • Marloes Prins,
  • Alibeth Andres Baquero Suarez,
  • Chelsea Deane,
  • Emilio Dijan,
  • Mahmoud Elfiky,
  • Laura Koskenvuo,
  • Aurore Thollot,
  • Bernard Limoges,
  • Carmen Capito,
  • Challine Alexandre,
  • Henri Kotobi,
  • Julien Leroux,
  • Kalitha Pinnagoda,
  • Nicolas Henric,
  • Olivier Azzis,
  • Olivier Rosello,
  • Poddevin Francois,
  • Sara Etienne,
  • Philippe Buisson,
  • Sophian Hmila,
  • Joe-Nat Clegg-Lamptey,
  • Osman Imoro,
  • Owusu Emmanuel Abem,
  • Dimitrios Papageorgiou,
  • Vasiliki Soulou,
  • Sabrina Asturias,
  • Lenin Peña,
  • Donal B O’Connor,
  • Alberto Realis Luc,
  • Alfio Alessandro Russo,
  • Antonio Taddei,
  • Camilla Cona,
  • Corrado Bottini,
  • Giovanni Pascale,
  • Giuseppe Rotunno,
  • Marco Maria Pascale,
  • Margherita Notarnicola,
  • Mario Corbellino,
  • Paolo Ubiali,
  • Roberto Cautiero,
  • Tommaso Bocchetti,
  • Elena Muzio,
  • Vania Guglielmo,
  • Eugenio Morandi,
  • Patrizio Mao,
  • Emilia De Luca,
  • Farah Mahmoud Ali,
  • Kestutis Strupas,
  • Paulius Kondrotas,
  • Robertas Baltrunas,
  • Juozas Kutkevicius,
  • Povilas Ignatavicius,
  • Choy Ling Tan,
  • Jia Yng Siaw,
  • Sir Young Yam,
  • Ling Wilson,
  • Mohamed Rezal Abdul Aziz,
  • John Bondin,
  • Carmina Diaz Zorrilla,
  • Anass Majbar,
  • Danjuma Sale,
  • Lawal Abdullahi,
  • Olabisi Osagie,
  • Adedeji Fatuga,
  • Agboola Taiwo,
  • Emeka Nwabuoku,
  • Marte BliksØen,
  • Zain Ali Khan,
  • Jazmin Coronel,
  • Cesar Miranda,
  • Idelso Vasquez,
  • Luis M. Helguero-Santin,
  • Adesina Adedeji,
  • Saleh Alqahtani,
  • Max Rath,
  • Michael Van Niekerk,
  • Modise Zacharia Koto,
  • Roel Matos-Puig,
  • Leif Israelsson,
  • Tobias Schuetz,
  • Mahmut Arif Yuksek,
  • Meric Mericliler,
  • Bernhard Wolf,
  • Cameron Fairfield,
  • Katharine Whitehurst,
  • Natalie Redgrave,
  • Caroluce K Musyoka,
  • Michael Cox,
  • Muhamed M H Farhan-Alanie,
  • Rory Callan,
  • Chali Chibuye,
  • Tebian Hassanein Ahmed Ali,
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  • Gabriel Pardo,
  • Ruth Blanco

DOI
https://doi.org/10.1136/bmjgh-2020-003429
Journal volume & issue
Vol. 5, no. 12

Abstract

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Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings.Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI).Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI.Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.