Infección nosocomial en postoperados de cirugía cardíaca

Camí, M T Guardia; Jordan, Iolanda; Ayala, Mireia Urrea

doi:10.1157/13124216

Cited by 21 publications

(16 citation statements)

References 17 publications

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“…Infections in children are frequent (13-31%) after cardiac surgery [1-7]. Many are surgical site infections (incidence 2.3-8%) [4, 5, 7-9], however, many are more serious, such as septicemia (incidence 6.3-15%) [3, 7, 10], mediastinitis (0.2-3.3%) [5, 8, 9, 11-13], and endocarditis (incidence 0.2%) [14-16].…”

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confidence: 99%

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Major Infection After Pediatric Cardiac Surgery: A Risk Estimation Model

Barker¹,

O’Brien²,

Welke³

et al. 2010

The Annals of Thoracic Surgery

120

106

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Background In pediatric cardiac surgery, infection is a leading cause of morbidity and mortality. We created a model to predict risk of major infection in this population. Methods Using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we created a multivariable model in which the primary outcome was major infection (septicemia, mediastinitis, or endocarditis). Candidate independent variables included demographic characteristics, comorbid conditions, preoperative factors, and cardiac surgical procedures. We created a reduced model by backward selection and then created an integer scoring system using a scaling factor with scores corresponding to percent risk of infection. Results Of 30,078 children from 48 centers, 2.8% had major infection (2.6% septicemia, 0.3% mediastinitis, and 0.09% endocarditis). Mortality and postoperative length of stay were greater in those with major infection (mortality: 22.2% vs. 3.0%; length of stay > 21 days: 69.9% vs. 10.7%). Young age, high complexity, previous cardiothoracic operation, preoperative length of stay >1 day, preoperative ventilator support, and presence of a genetic abnormality were associated with major infection after backward selection (p<0.001). Estimated infection risk ranged from <0.1% to 13.3%; the model discrimination was good (c-index 0.79). Conclusions We created a simple bedside tool to identify children at high risk for major infection after cardiac surgery. These patients may be targeted for interventions to reduce the risk of infection and for inclusion in future clinical trials.

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confidence: 99%

“…Several studies have evaluated risk factors for post-operative infection such as: longer pre-operative and ICU stay, longer length of admission, open chest after surgery, cyanotic heart disease, younger age, and higher complexity score [1, 3, 7]. These studies, however, have been performed at single centers and are limited by small sample sizes.…”

mentioning

confidence: 99%

Major Infection After Pediatric Cardiac Surgery: A Risk Estimation Model

Barker¹,

O’Brien²,

Welke³

et al. 2010

The Annals of Thoracic Surgery

120

106

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“…Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in children following cardiac surgery in Brazil and European countries [1-3]. Its reported incidence ranges from 17.1 to 42.8 episodes per 1000 ventilator-days and it is associated with increased duration of mechanical ventilation, increased length of pediatric intensive care unit (PICU) and hospital stay and higher mortality rates [1,2,4].…”

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confidence: 99%

Role of soluble triggering receptor expressed on myeloid cells-1 for diagnosing ventilator-associated pneumonia after cardiac surgery: an observational study

Matsuno

Carlotti

2013

BMC Cardiovasc Disord

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BackgroundThe diagnosis of ventilator-associated pneumonia (VAP) is a challenge, particularly after cardiac surgery. The use of biological markers of infection has been suggested to improve the accuracy of VAP diagnosis. We aimed to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in the diagnosis of VAP following cardiac surgery.MethodsThis was a prospective observational cohort study of children with congenital heart disease admitted to the pediatric intensive care unit (PICU) after surgery and who remained intubated and mechanically ventilated for at least 24 hours postoperatively. VAP was defined by the 2007 Centers for Disease Control and Prevention criteria. Blood, modified bronchoalveolar lavage (mBAL) fluid and exhaled ventilator condensate (EVC) were collected daily, starting immediately after surgery until the fifth postoperative day or until extubation for measurement of sTREM-1.ResultsThirty patients were included, 16 with VAP. Demographic variables, Pediatric Risk of Mortality (PRISM) and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 scores, duration of surgery and length of cardiopulmonary bypass were not significantly diferent in patients with and without VAP. However, time on mechanical ventilation and length of stay in the PICU and in the hospital were significantly longer in the VAP group. Serum and mBAL fluid sTREM-1 concentrations were similar in both groups. In the VAP group, 12 of 16 patients had sTREM-1 detected in EVC, whereas it was undetectable in all but two patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, specificity 0.86, positive predictive value 0.86, negative predictive value 0.75, positive likelihood ratio (LR) 5.25, negative LR 0.29).ConclusionMeasurement of sTREM-1 in EVC may be useful for the diagnosis of VAP after cardiac surgery.

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“…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.…”

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“…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.…”

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