Surgical site infections in a longitudinal cohort of neonatal intensive care unit patients.

OBJECTIVE: To estimate the incidence and identify risk factors for surgical site infections (SSIs) among infants in the neonatal intensive care unit (NICU). STUDY DESIGN: A prospective cohort study of infants undergoing surgical procedures from May 2009 to April 2012 in three NICUs was performed. SSI was identified if documented by an attending neonatologist and treated with intravenous antibiotics. Independent risk factors were identified using logistic regression, adjusting for NICU. RESULT: A total of 902 infants underwent 1346 procedures and experienced 60 SSIs (incidence: 4.46/100 surgeries). Risk factors for SSIs included younger chronological age (odds ratio (OR) 1.03 per day decrease, 95% confidence interval (CI) 1.01, 1.04), lower gestational age (OR 1.09 per week decrease, CI 1.02, 1.18), male sex (OR 1.17, CI 1.04, 1.34) and use of central venous catheter (OR 4.40, CI 1.19, 9.62). Only 43% had surgical site cultures obtained and Staphylococcus aureus was most commonly isolated. CONCLUSION: SSIs complicated 4.46% of procedures performed in the NICU. Although few modifiable risk factors for SSIs were identified, future efforts should focus on evaluating the impact of current prevention strategies on the incidence of neonatal SSI.

Effect of respiratory infection on tissue riboflavin and flavin enzymes in mice.

The effects of Klebsiella pneumoniae infection on red blood cell and liver riboflavin levels and a few flavin enzymes were examined to verify our earlier hypothesis based on human experience that upper respiratory infections result in mobilization of riboflavin from tissues into blood, resulting in a rise in red blood cell riboflavin and an increased saturation of erythrocyte glutathione reductase (EGR) with its coenzyme flavin adenine dinucleotide (FAD; reduction in EGR activation coefficient, AC, values). Thirty-six-day-old male mice fed a diet marginally sufficient in riboflavin were injected with a single sublethal dose of K. pneumoniae. Batches of control, deficient infected and deficient uninfected animals were killed during the peak period of infection and after recovery. Infection brought about a significant rise in basal EGR activity due to greater saturation with coenzyme FAD and a concomitant reduction in EGR-AC values. On recovery, basal EGR activity decreased, and EGR-AC values increased to levels beyond control values, suggesting riboflavin deficiency. In the liver, acyl-coenzyme A dehydrogenase showed a significant decrease and pyridoxamine-phosphate oxidase activity a significant increase. Both the enzymes normalized after recovery. D-amino acid oxidase activity did not change.