Surgical Site Infections in Pediatric Patients with Diabetes Mellitus

Authors:
Amira Elfergani, Gehan Bensreiti, Yehya Maitah

Body of Abstract:
Background
Surgical site infections (SSIs) are a significant concern, particularly in those with diabetes mellitus (DM), due to hyperglycemia, compromised immune function, and delayed wound healing. Pediatric patients with DM face unique challenges, such as the role of insulin pumps and autoimmune dysfunction, which complicate direct application of adult findings. However, much of the evidence surrounding SSIs in this population is extrapolated from adult studies. This review explored the risk factors and preventive strategies for SSIs in pediatric DM patients, highlighting areas of agreement, disagreement, and significant gaps in the current knowledge.

Methods
This review analyzed findings from work published between 2009 and 2024 that addressed the relationship between DM and SSIs. Articles were selected based on their relevance to hyperglycemia, immune dysfunction, perioperative management. Primary sources included systematic reviews, meta-analyses, and clinical guidelines.

Results
There is agreement that DM significantly increases the risk of SSIs in surgical patients. Most studies, including large meta-analyses, highlight hyperglycemia as a key modifiable risk factor. However, discrepancies exist regarding the exact threshold of glycemic control required to mitigate this risk. While most studies advocate maintaining glucose levels below 180 mg/dL, others suggest stricter thresholds for pediatric populations. Pediatric-specific data are sparse, with researchers often relying on extrapolation from adult studies. Another area of agreement is the role of immune dysfunction in predisposing diabetic patients to infections. Studies emphasize compromised neutrophil function, chemotaxis, and cytokine production as consistent contributors to SSI risk. Additional mechanisms, such as gut microbiota dysbiosis, may play an under explored role in infection susceptibility, particularly in pediatric populations. Perioperative measures such as maintaining normothermia and minimizing operative times are consistently supported. Postoperative insulin protocols are widely endorsed for adults, but evidence of their effectiveness in pediatric populations remains limited. Timely antibiotic prophylaxis is another area of agreement, with research emphasizing its importance in reducing SSI incidence. The choice of antibiotics and timing of administration needs to be tailored for children with DM, especially considering rising antimicrobial resistance.

Conclusions
This review highlights the increased SSI risk in diabetic surgical patients and the importance of glycemic control, immune function, and perioperative management in mitigating this risk. However, significant gaps remain, particularly concerning pediatric-specific data. Discrepancies in the literature regarding the predictive value of glycemic markers and the optimal thresholds for control underscore the need for further research.