Risk factors for infection after cardiovascular surgery in children in Argentina

Abstract

Infections after cardiovascular surgery are an important cause of morbidity and mortality. This paper described the study of risk factors associated with development of infections. This is a prospective study, setting in a Hospital JP Garrahan, a tertiary and referral center of Buenos Aires, Argentina. All patients with cardiac surgeries between 1/ 11/01 to 1/1/ 2002 were included. The median age of p was 30 months (r: 1-212 m), 184 p (53%) were boys, 21% (75) had underlying disease, being the genetic disorders or undernutrition the most frequent, 56 p (16%) had previous surgery, 36 p (10%) had received previous antibiotics and 30 (9%) of them had previous infection, An ASA score higher than or equal to 3 was found in 308 p (88%). Median hospital stay before surgery was 1 day (r1-120 d), 88 p (25%) nedeed inotropic support with epinephrine, 147 p (42%) needed mechanical ventilation during a median time of 4 days (r: 1-66d).Drainage with thorax opened was done in 339p (97%) for a median time of 2 days (r:1-7d). Total hospital stay was between 1 and 120 days (median 5 days). Postsurgical infections developed in 38 of 350p (11%). Superficial wound infection in 4 p (1%), 5 p (1.5%) had deep infection, 3p (1%) had mediastinitis and 26 p (7.5%) had other nonsurgical infections Eleven p (3%) died. By multivariate study underlying diseases (p<0.012) OR 4.22 (CI 1.38-12.8), inotropic support with epinephrine (p<0.027) OR 4.04 (CI 1.17-13.9) and postoperative stay longer than 12 days were found to be risk factors for infections. We concluded that presence of underlying diseases, longer hospitalization and inotropic support were risk factors for infections.

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

“…It is similar to the study by Levy et al[5] from Israel. Our HAI rate (16%) is higher compared to the data from Rosanova et al[11] with the incidence of 11%. Present HAI rate in our cohort of patients (16%) has decreased by almost 50% compared to a similar study (32%) in this institute in 2007.…”

“…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.…”

“…Statistically significant difference in surgical duration, CPB time, and aortic cross-clamp time was observed between the groups with and without infection as was found in other studies. [111617] However, in multivariate regression analysis, only CPB duration and preoperative hospital stay were statistically significant. Inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate were not found to be useful in detecting HAI.…”

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

“…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.…”