Case-Control Study of Pediatric Cardiothoracic Surgical Site Infections

Holzmann-Pazgal, Galit; Hopkins-Broyles, Diane; Recktenwald, Angela; Hohrein, Melinda; Kieffer, Patricia; Huddleston, Charles B.; Sharma, Anita; Fraser, Victoria J.

doi:10.1086/524323

Cited by 41 publications

(30 citation statements)

References 10 publications

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“…Numerous studies in cardiac surgery have shown that operation time is a risk factor for SSIs. 8,9,12,13) This supports the results in this study. Low body temperature during surgery was also found to be a risk factor for SSIs by McAnally, et al 27) Our results also showed that lowest rectal temperature was a significant factor affecting mediastinitis.…”

Section: Discussionsupporting

confidence: 91%

“…3,[8][9][10][11][12][13] At our hospital, because we experienced an outbreak of SSIs caused by MRSA, the incidence of SSIs prior to the introduction of SSI prevention measures was remarkably high, at 17.0%, and mediastinitis accounted for 70% of cases. SSI prevention measures were therefore an urgent issue, and we collaband the degree of each procedure difficulty in congenital heart surgery.…”

Section: Discussionmentioning

confidence: 95%

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Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

Katayanagi

2015

ATCS

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Background: Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA)is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution. Methods: Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated. Results: The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were "duration of preoperative hospitalization" and "preoperative MRSA colonization," intraoperative factors were "Aristotle basic complexity score," "operation time," "cardiopulmonary bypass circuit volume" and "lowest rectal temperature." And postoperative factor was "blood transfusion volume." Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis. Conclusions: SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

Katayanagi

2015

ATCS

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“…22,23 By contrast, almost all pediatric studies of SSI to date have focused on risk factors for development of infection, particularly after cardiac surgery, rather than the efficacy of selected interventions, [24][25][26][27][28][29][30][31] and the few observational studies that have tested the association of preoperative antibiotics and the development of SSI were unable to establish one. 26,27 In 1 interventional trial to reduce SSIs in children, Adler and colleagues performed a retrospective, single-center analysis of a program initiated to address high rates of wound infections after cardiac surgery. 32 The intervention, which included emphasis on correct timing of prophylactic antibiotics, resulted in a marked decrease in the incidence of postoperative wound infection.…”

Section: Discussionmentioning

confidence: 99%

A Statewide Collaborative to Reduce Pediatric Surgical Site Infections

et al. 2014

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BACKGROUND: Surgical site infections (SSIs) are preventable events associated with significant morbidity and cost. Few interventions have been tested to reduce SSIs in children.METHODS: A quality improvement collaboration was established in Ohio composed of all referral children' s hospitals. Collaborative leaders developed an SSI reduction bundle for selected cardiac, orthopedic, and neurologic operations. The bundle was composed of 3 elements: prohibition of razors for skin preparation, chlorhexidinealcohol use for incisional site preparation, and correct timing of prophylactic antibiotic administration. The incidence of SSIs across the collaborative was compared before and after institution of the bundle. The association between 1 of the bundle elements, namely correct timing of antibiotic prophylaxis, and the proportion of centers achieving 0 SSIs per month was measured.RESULTS: Eight pediatric hospitals participated. The proportion of months in which 0 SSIs per center was recorded was 56.9% before introduction of the bundle, versus 81.8% during the intervention (P , .001). Correct timing of preoperative prophylactic antibiotics also significantly improved; 39.4% of centers recorded correct timing in every eligible surgical procedure per month ("perfect timing") before the intervention versus 78.7% after (P , .001). The achievement of 0 SSIs per center in a given month was associated with the achievement of perfect antibiotic timing for that month (P , .003). CONCLUSIONS:

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“…They also shown that 70 % (95 % CI 67 -73 %) of the patients staying longer than 21 days in patients that experienced a major infection versus only 11% (95% CI 10 -11 %) of patients without major infections (Barker et al 2010). Holzmann-Pazgal et al similarly showed that surgical site infection was associated with longer ICU stays, longer hospital stays, and was associated with an increased risk of death after adjusting for illness severity (OR 4.9 (95% CI 1.1-22.8), p=0.04) (Holzmann-Pazgal et al 2008). …”

Section: Infectious Diseasementioning

confidence: 99%

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

Jean‐St‐Michel

Meza

Coles

et al. 2017

The Journal of Heart and Lung Transplantation

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We investigated patient and procedural factors associated with failure of staged palliation after the Norwood procedure in patients with right ventricular dysfunction (RVDfx).Patients from the Pediatric Heart Network Single Ventricle Reconstruction (SVR) Trial dataset were selected if RVDfx was present, defined as an ejection fraction of less than 44% and a fractional area of change of less than 35% on the post-Norwood echocardiogram. Transplantfree survival after the Norwood procedure was analyzed using multiphase parametric hazard analysis and factors associated with death or transplant were identified.In the SVR cohort, 123 (34%) infants had RVDfx. The six-month transplant-free survival was 87% (70%CI 82-91%). The independent factors associated with increased risk of death or transplant were BT shunt, increased RV size, infectious disease complications and low surgeon volume.Patient factors can help identify which patient with RVDfx is at higher risk of death and help decision making around early transplant listing.iii

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Case-Control Study of Pediatric Cardiothoracic Surgical Site Infections

Abstract: "Case-control study of pediatric cardiothoracic surgical site infections

Cited by 41 publications

References 10 publications

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

A Statewide Collaborative to Reduce Pediatric Surgical Site Infections

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

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