Nosocomial infections in infants and children after cardiac surgery

Abstract

Objective: To identify the incidence, characteristics and risk factors of nosocomial infections (NIs) in infants and children undergoing open heart surgery, a prospective observational study. Methods: One hundred consecutive infants and children < 2 yrs of age undergoing open heart surgery (OHS) between March 2007 and December 2007 were included in the study. Samples for blood, endotracheal and urine culture were drawn daily during intensive care unit (ICU) stay. Cultures from endotracheal tube, central venous catheter, arterial cannula, chest tube, urinary catheter and other invasive lines were also obtained. Centers for Disease Control and Prevention criteria were used for defining NIs. A number of possible risk factors predisposing to NI were analyzed. Results: 32% patients developed NI. The NI rate was 49%. Common NIs were bloodstream infection (19%), respiratory tract infection (17%), catheter site infection (7%) and urinary tract infection (6%). Common pathogens were Acinetobacter (22.5%), Pseudomonas aeruginosa (20.4%), Klebsiella pneumoniae (16.3%) and Staphylococcus aureus (12.2%). Major risk factors for NI were length of ICU stay (p < 0.001), duration of intubation (p < 0.001), reintubation (p < 0.001), duration of central venous catheterization (p = 0.001), preoperative congestive heart failure (p = 0.002), tracheostomy (p = 0.003), duration of preoperative stay (p = 0.01), blood transfusion (p = 0.01), preoperative balloon atrial septostomy (p = 0.02), duration of surgery (p = 0.03), surgical complexity score (p = 0.03) and hypothermia (p = 0.03). The mortality rate was 11% with significant association between NI and death (p = 0.002). Conclusion: NIs develop frequently in infants and children after OHS. This study may serve as a reference point for further development and implementation of interventions aimed at reducing NI rates and improving patient outcome. (Ind J Thorac Cardiovasc Surg 2008; 24: 233-239)

Hospital-acquired infection: Prevalence and outcome in infants undergoing open heart surgery in the present era

“…There was also statistically significant increase in ventilation duration, ICU and hospital stay, and mortality in patients with HAI compared to noninfected patients, same was observed by other studies too. [6111318] We also observed that the antibiotic resistance profile has changed over time for the worse with more and more drug-resistant pathogens, with more Gram-negative bacteria causing HAI, as has been reported by MacVane. [19] This suggests a need to decrease sources of infections such as invasive device days and provide more effective antibiotic prescribing practices to have the greatest overall impact on HAIs.…”

Health-care associated infections in children after cardiac surgery in a pediatric cardiac intensive care unit (PCICU)

“…The low incidence of HAIs in our study, compared to the Indian cohort [5], may reflect strict implementation and adherence to the institutional Infection Control (IC) policy including strict visit regulations (one parent at a time), hand hygiene and an 1:1 nurse-to-patient ratio in high dependency/intensive care areas. An inverse correlation between HAI rates and nursing hours to patient day ratio had been reported in a previous cohort [2].…”

“…In the hospital setting of developing countries, where sub-optimal infection control and resource utilization may adversely affect surgical outcome, HAI rates are predictably higher (e.g 49% in India) than those in developed countries where rates range from 5.5% to 30.8% [2,3,4,5]. We report the frequency of HAIs and the associated case fatality rate among post-cardiac surgery pediatric patients admitted to the cardiac intensive care unit (CICU), at the Aga Khan University (AKU), Karachi, Pakistan between January 2008 and June 2009.…”

Risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease

“…The more complicated the operation, the longer the operation time, and the worse the outcome of the patient [26]. Duration of surgery and surgical complexity score are all risk factors of nosocomial infections in infants and children undergoing open heart surgery [20,27]. The possible cause is that the risk of bacterial contamination and cell damage increases at the surgical site as the operation time increases.…”