The magnitude of surgical site infection and its associated factors among pediatric central nervous system (CNS) tumor patients at tertiary referral hospitals in Ethiopia: a multi-center study.
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PURPOSE: Surgical site infections (SSIs) represent a leading cause of postoperative morbidity in pediatric neurosurgery, particularly among patients with central nervous system (CNS) tumors. Although global SSI rates range from 1% to 10%, there is limited data from low-resource settings such as Ethiopia. This study aimed to determine the magnitude of SSIs and identify associated risk factors among pediatric CNS tumor patients treated at tertiary referral hospitals in Ethiopia. METHODS: A retrospective cross-sectional study was conducted by reviewing 250 medical records of pediatric CNS tumor patients who underwent surgery between April 2019 and January 2024 at Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Data were collected using a structured checklist questionnaire and analyzed using SPSS version 27. Descriptive statistics were used to summarize and characterize the study cohort in terms of demographic, clinical, and tumor-related variables. To identify factors associated with surgical site infections (SSI), both bivariable and multivariable logistic regression analyses were performed. Bivariable analysis initially assessed the relationship between each independent variable and SSI, while multivariable logistic regression adjusted for potential confounders to determine independent predictors of SSI.I. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated; statistical significance was set at p < 0.05. RESULTS: A total of 250 patients were included in the study, with over one-third (33.6%) aged 5–9 years. Embryonal tumors, particularly medulloblastoma, were the most common pediatric brain tumors (97, 39%), followed by gliomas (60, 24%). About 40% (n = 101) of patients had a symptom-to-diagnosis interval of 1–3 months. Tumor location in the fourth ventricle (posterior fossa) was identified in 40% of cases.Tumor size ranged from 3 to 6 cm in maximum diameter in 55.9% of cases. Hydrocephalus was documented in 77% (n = 192) of patients, and 75.2% underwent cerebrospinal fluid (CSF) diversion procedures. Gross total tumor resection (GTR) was achieved in 152 out of 250 patients (60.4%). Near-total resection was performed in 43 patients (17.2%), while biopsy only was done in 27 patients (10.8%). Histopathological grading revealed that 41.6% of the tumors were WHO grade IV. The overall prevalence of surgical site infections (SSI) in this study was 51% (95% CI: 44.8–57.5). Independent predictors of SSI included rural residence (AOR = 14.9), severe acute malnutrition (AOR = 13.4), tumor size > 6 cm (AOR = 7.2), metastasis (AOR = 2.9), post-surgical PICU admission (AOR = 4.6), and prolonged PICU stay > 48 h (AOR = 4.3). Most infections were deep (79.7%) and often resulted in re-admissions and extended hospitalizations. At one-year follow-up, 106 patients were alive, while 77 had died. CONCLUSION: This study demonstrates a markedly high burden of surgical site infections (SSI) among Ethiopian pediatric patients with CNS tumors. The identification of modifiable risk factors highlights the urgent need for targeted infection prevention strategies, enhanced ICU care, multidisciplinary team (MDT) management, and capacity-building initiatives to improve surgical Site infections and outcomes in resource-limited settings.