Bedside prediction rule for infections after pediatric cardiac surgery

Abstract

PurposeInfections after pediatric cardiac surgery are a common complication, occurring in up to 30% of cases. The purpose of this study was to develop a bedside prediction rule to estimate the risk of a postoperative infection.MethodsAll consecutive pediatric cardiac surgery procedures between April 2006 and May 2009 were retrospectively analyzed. The primary outcome variable was any postoperative infection, as defined by the Center of Disease Control (2008). All variables known to the clinician at the bedside at 48 h post cardiac surgery were included in the primary analysis, and multivariable logistic regression was used to construct a prediction rule.ResultsA total of 412 procedures were included, of which 102 (25%) were followed by an infection. Most infections were surgical site infections (26% of all infections) and bloodstream infections (25%). Three variables proved to be most predictive of an infection: age less than 6 months, postoperative pediatric intensive care unit (PICU) stay longer than 48 h, and open sternum for longer than 48 h. Translation into prediction rule points yielded 1, 4, and 1 point for each variable, respectively. Patients with a score of 0 had 6.6% risk of an infection, whereas those with a maximal score of 6 had a risk of 57%. The area under the receiver operating characteristic curve was 0.78 (95% confidence interval 0.72–0.83).ConclusionsA simple bedside prediction rule designed for use at 48 h post cardiac surgery can discriminate between children at high and low risk for a subsequent infection.

Infecciones asociadas a la atención en salud (IAAS) en pacientes pediátricos post-operados de cardiopatías congénitas

“…La edad del paciente menor a 6 meses, estadía mayor a 48 h en UPC-P y esternón abierto por más de 48 horas fueron considerados por Alegra y cols., como factores predictores para un mayor riesgo de infección 1 . La estadía prolongada está comúnmente asociada con mayor duración de la ventilación mecánica y aumento en el tiempo de uso de catéteres intravasculares [25][26][27][28] .…”

“…Se han reportado incidencias que van de 16 a 31%, más alta que la observada en los pacientes hospitalizados en unidades de cuidados intensivos pediátricos general. Está ampliamente reportada su asociación con aumento en los días de hospitalización, costos asociados a la intervención, uso de antimicrobianos y riesgo de mortalidad [1][2][3][4][5][6][7][8] . Los tipos más comunes de IAAS reportadas en pacientes pediátricos post operados de cirugía cardíaca son las infecciones del sitio quirúrgico y del torrente sanguíneo.…”

“…Los tipos más comunes de IAAS reportadas en pacientes pediátricos post operados de cirugía cardíaca son las infecciones del sitio quirúrgico y del torrente sanguíneo. Entre los factores de riesgo que han sido identificados previamente están: menor edad al momento de la cirugía, mayor complejidad quirúrgica, mayor duración de la cirugía y del bypass cardiopulmonar, mayor estadía en la unidad de cuidados intensivos y retraso en el cierre esternal [1][2][3][4][5][6][7][8] . El Hospital Clínico de la Pontificia Universidad Católi-ca de Chile (PUC) es un centro de referencia nacional para la resolución de las cardiopatías congénitas operables en menores de 15 años.…”

Risk Factors for Death or Heart Transplant for Patients with Right Ventricular Dysfunction After the Norwood Procedure: A Secondary Analysis of the Single Ventricle Reconstruction Trial

“…Infection in children post-congenital heart surgery is a frequent complication, with a reported incidence as high as 30 % (Pollock et al 1990;Pasquali et al 2013;Ben-Ami et al 2008;Algra et al 2012). Some of the infections are superficial surgical wound infections.…”

“…Multiple groups have studied risk factors associated with developing an infection post-pediatric cardiac surgery. Algra et al identified age less than six months, a post-operative ICU stay longer than 48 hours, and an open sternum for more than 48 hours as risk factors for infection (Algra et al 2012). Costello et al identified age younger than one year and longer cardiopulmonary bypass duration as independent risk factors for infection post-cardiac surgery (Costello et al 2010).…”