title: Incidence of surgical site infections in children: active surveillance in an Italian academic children's hospital.
abstract: Surgical Site Infections (SSIs) account for 16-34% of all health-care associated infections. This study aimed to assess the incidence rate of SSIs in children who underwent surgical procedures in an academic children's hospital in Italy.
  
  
  
  Prospective cohort study.
  
  
  
  We actively followed-up 0-17 year old children at 30 days of surgical procedures without implants conducted during one index week per quarter, from the second quarter of 2014, to the first quarter of 2016 (8 index weeks in total). Follow up data were collected by telephone interview, or derived by clinical records if patients were still hospitalized. SSIs were defined according to case definitions of Centers for Diseases Control, Atlanta, USA. We calculated cumulative incidence of SSIs per 100 surgical procedures, by patient characteristics, procedure characteristics, and quarter. To investigate variables associated with SSIs, we compared characteristics of procedures with SSIs with those of procedures without SSIs.
  
  
  
  Over the study period, SSI incidence was 1.0% (19 cases/1,830 surgical procedures). SSI incidence was significantly lower after ear, nose and throat procedures compared to all other procedures, and significantly decreased over time. Duration of surgery was a risk factor for SSIs; patients with SSIs had a significantly longer total length of stay (LOS), due to a prolonged post-operative LOS.
  
  
  
  As reported in adults, this study confirms that SSIs are associated with longer hospitalizations in children. Active surveillance of SSIs is an important component of the overall strategy to reduce the incidence of these infections in children.
authors.affiliation: Unit of Clinical Epidemiology, Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Ciofi Degli Atti
authors.affiliation: Unit of Clinical Epidemiology, Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Serino
authors.affiliation: Unit of Clinical Epidemiology, Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Piga
authors.affiliation: Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: A E
authors.initials: AE
authors.lastname: Tozzi
authors.affiliation: Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Raponi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology
keywords: Children; Surgical site infections; Surveillance