Colonization of multidrug resistant pathogens in a hybrid pediatric cardiac surgery center

Abstract

IntroductionThe incidence of multidrug resistant microorganisms worldwide is increasing. The aim of the study was to present institutional experience with the multidrug resistant microorganism colonization patterns observed in children with congenital heart diseases hospitalized in a hybrid pediatric cardiac surgery center.Material and methodsMicrobiological samples were routinely collected in all children admitted to our department. All microbiological samples were analyzed with regard to multidrug resistant microorganisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Gram-negative rods producing extended-spectrum beta-lactamases (ESBL), multidrug resistant Gram-negative rods (MDR-GNRs), carbapenemase-producing Klebsiella pneumoniae (KPC), carbapenem-resistant Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA).ResultsIn 30 (9%) swabs ‘alert’ pathogens from the above group of listed microorganisms were found. All positive swabs were isolated in 19 (16.1%) children. Multidrug resistant pathogen colonization was statistically significantly more often observed in children admitted from other medical facilities than in children admitted from home (38% vs. 10%, p = 0.0089). In the group of children younger than 6 months ‘alert’ pathogen were more often observed than in older children (34.1% vs. 5.4%, p < 0.001).ConclusionsPreoperative multidrug resistant pathogen screening in children admitted and referred for congenital heart disease procedures may be of great importance since many of these patients are colonized with resistant bacteria. Knowledge of the patient's microbiome is important in local epidemiological control along with tailoring the most effective preoperative prophylactic antibiotic for each patient. The impact of preoperative screening on postoperative infections and other complications requires further analysis.

Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) colonization as a risk factor for developing ESBL infections in pediatric cardiac surgery patients: “retrospective cohort study”

“…This finding is similar to those reported in colonization screening by other authors [20]. It could be interesting to discuss whether screening for MDRB in our setting should be done only with anal swab (just one site of sampling), with the objective of enhancing the cost-effectiveness of MDRB screening.…”

“…We found 15% ESBL colonization, similar to a Polish study on the same population (16% MDRB) [20] and to a reported colonization rate in a 2012 report from France (15%) [22]. However, it was lower than those reported by Kim et al in a Korean study of intensive care unit patients (28.2%) [21]; in another recent Korean study, the authors reported a rate of 42.5% in ICU patients and 20.3% even in healthy persons [23].…”

“…It could be interesting to discuss whether screening for MDRB in our setting should be done only with anal swab (just one site of sampling), with the objective of enhancing the cost-effectiveness of MDRB screening. The most common isolated species were Klebsiella pneumoniae in our study, while others reported higher frequencies of Escherichia coli isolation [20]. …”

“…Multidrug-resistant bacteria (MDRB) screening is recommended as a standard protocol for all cardiac surgery patients [20]. Kim et al [21] suggest that in a non-epidemic situation, systematic detection of ESBLs in ICU patients is not cost-effective, and that stringent contact precaution for infected patients might be adequate.…”

Postoperative kinetics of common inflammatory biomarkers after congenital heart defect procedures with extracorporeal circulation in children

“…There is still a lack of definitive guidelines to provide proper antibiotic prophylaxis in children undergoing cardiac surgery, especially with relation to extracorporeal circulation [7,8]. There are many reasons why many discussions about limiting antibiotic use and the duration of prophylaxis in pediatric cardiac surgery still didn't led to precise guidelines, while several publications encourage cardiothoracic centers to consider a change [9].…”