Burden of Pediatric Infections Requiring Surgery: Results from an Ugandan Tertiary Care Center
Author(s):
David Grabski; Nassar Kakembo; Tamara Fitzgerald; Maija Cheung; John Sekabira; Doruk Ozgediz
Background: The burden of pediatric infections requiring operative intervention in low-middle income countries (LMIC) is poorly defined. The increased prevalence of infectious diseases necessitating operative intervention may tax the limited availability of surgical and intensive care resources.
Hypothesis: The operative volume resulting from pediatric infections represents a significant portion of the total surgeries performed in LMIC.
Methods: A retrospective review of all pediatric surgical patients (<14 years) presenting to an Ugandan tertiary referral hospital from Jan 2012 to Aug 2016. Infections present at admission treated by the pediatric surgery team were analyzed by operative intervention and overall mortality.
Results: Of 3,494 patients treated over the time period, 18.9% (n=662) were admitted with a surgical infection (Table 1). 46.9% were girls and 53.1% were boys with a median age of 2 years (IQR 0.24- 6.9 years). 63.5% (n=417) of patients presenting with an infection underwent an operation with an in-hospital mortality of 10.6% (n=70). This represented 20.1% of the total operative volume of the pediatric surgery department. The most common infections included superficial infections and abscesses (47.2%), typhoid perforations (13.5%), appendicitis (10.7%) and abdominal sepsis (7.4%). The mortality for children presenting with abdominal sepsis was 59.1% (n=29/49), necrotizing enterocolitis was 50% (7/14), and neonatal sepsis was 28.6% (n=4/14).
|
Surgical Infection
|
n (%)
|
Operation (%)
|
Morality (%)
|
|
Cellulitis/Abscess (total)
|
311 (47.2%)
|
64.7%
|
0.96%
|
|
Phycomycosis
|
3 (0.5%)
|
33.3%
|
33.3%
|
|
Necrotizing Fasciitis
|
30 (4.55%)
|
43.3%
|
10.0%
|
|
Wound Sepsis
|
7 (1.1%)
|
0%
|
0%
|
|
Surgical Site Infection
|
8 (1.2%)
|
62.5%
|
12.5%
|
|
Primary Peritonitis
|
25 (3.79%)
|
72.0%
|
4.0%
|
|
Appendicitis
|
71 (10.8%)
|
90.0%
|
0%
|
|
Typhoid Bowel Perforation
|
89 (13.5%)
|
88.8%
|
16.9%
|
|
Abdominal Sepsis
|
49 (7.4%)
|
28.6%
|
59.2%
|
|
Thyroglossal Duct Cyst
|
7 (1.1%)
|
85.7%
|
0%
|
|
Thoracic Empyema
|
2 (0.3%)
|
75.0%
|
0%
|
|
Pneumonia
|
9 (1.4%)
|
11.1%
|
55.6%
|
|
Septic Arthritis/Osteomyelitis
|
4 (0.6%)
|
75.0%
|
0%
|
|
Necrotizing Enterocolitis
|
14 (2.1%)
|
28.6%
|
50.0%
|
|
Neonatal Sepsis
|
14 (2.1%)
|
35.7%
|
28.6%
|
|
Other
|
13 (2.0%)
|
23.1%
|
0%
|
Other: Cervical Adenitis, Parotitis, Genital Warts, Cholangitis, Orchitis, Recurrent Urinary Tract Infection, Measles
Conclusions: The operative volume of pediatric infections was 20%, representing a significant proportion of the total surgery performed. This finding should inform resource allocation given the current limitation in access to essential surgical care in LMIC and that emergent cases can push back elective cases leading to backlog. The highest mortality rates were abdominal sepsis and neonatal sepsis, highlighting the need for pediatric intensive care in LMIC.