Nosocomial Infections in Pediatric Cardiac Surgery, Italy

Valera, Mariangela; Scolfaro, Carlo; Cappello, N.; Gramaglia, Elena; Grassitelli, Sergio; Abbate, Maria Teresa; Rizzo, Alberta; Abbruzzese, Pietro A.; Valori, Andrea; Longo, Stefano; Tovo, Pier Angelo

doi:10.1086/501861

Cited by 43 publications

(63 citation statements)

References 24 publications

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“…The in-hospital patient infection rate of 16% in our study was relatively low: the overall [in-hospital] rates reported in previous studies were between 16% and 31% [22][23][24]. The SSI rate of 5.5% (in-hospital SSI rate, 4.4%) in this study was in line with the previous findings ( Table 1).…”

Section: Postoperative Infection Ratessupporting

confidence: 91%

“…The SSI rate of 5.5% (in-hospital SSI rate, 4.4%) in this study was in line with the previous findings ( Table 1). The BSI rate detected was relatively low compared to the rates reported earlier [22][23][24]259]. The HAI rates, however, were reported differently from study to study, and only the crude patient infection proportion was available for comparison, which is likely to be distorted.…”

Section: Postoperative Infection Ratesmentioning

confidence: 69%

“…The risk factors for SSI in these studies included young (neonatal) age, cyanotic heart disease, a high ASA score, an extended preoperative hospital stay, prolonged duration of surgery, an open chest postoperatively, and extended mechanical ventilation [20][21][22][23][24]. However, the widely used NNIS risk index score, which stratifies patients according to three risk factors (an ASA score ≥3, a wound contamination classification of either contaminated or dirty, and a duration of operation longer than the 75 th percentile of the duration for each operative procedure) [110,111] did not seem to adequately stratify pediatric cardiac surgery patients [112,113].…”

Section: Surgical Site Infectionsmentioning

confidence: 99%

“…CVC data was available for 580 (83%) primary BSIs and 75% of those were CVC-associated. In total, 27,279 blood samples were obtained for culture (median 62; range by year, 48-91 cultures per 1,000 patientdays), and 27 BSIs were confirmed per 1,000 blood cultures (range by year, [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

Section: Characteristics Of Patients With Bloodstream Infectionsmentioning

confidence: 99%

“…In adults undergoing coronary artery bypass surgery, SSIs reportedly occur after 8%-10% of procedures [18,19], and a considerable proportion of these infections was reportedly detected after discharge. Pediatric studies on open-heart surgery patients to date have reported lower SSI rates [20][21][22][23], suggesting that other types of HAI predominate in these patients [22][23][24]. However, none of these studies had conducted postdischarge surveillance, which may have affected the SSI rates.…”

Section: Introductionmentioning

confidence: 99%

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314 Healthcare-Associated Infections in Pediatrics

SpringerReference

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Helsinki 2008 P u b l i c a t i o n s o f t h e N a t i o n a l P u b l i c H e a l t h I n s t i t u t e K T L A 1 1 / 2 0 0 8 Dr. Alexander Langmuir, 1963 Emmi Sarvikivi, Healthcare-associated infections in pediatrics Publications of the National Public Health Institute, A11/2008, 93 Pages ISBN 978-951-740-803-5; 978-951-740-804-2 (pdf-version) ISSN 0359-3584; 1458-6290 (pdf-version) http://www.ktl.fi/portal/4043 ABSTRACT Background and aims. Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions, such as patients treated in intensive care units, or patients who have undergone medical procedures, e.g., surgery. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery.Methods. The Hospital for Children and Adolescents of the Helsinki University Central Hospital has participated in the BSI surveillance of the Finnish Hospital Infection Program since 1999. These data were utilized in all studies. The epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined. The S. marcescens isolates were genotyped with pulsed-field gel electrophoresis and the C. parapsilosis blood culture isolates (obtained between the years 1990 and 2002) with Southern blot hybridization by use of a DNA fingerprinting probe. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for those patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs after open-heart surgery.Results. During 1999During -2006, the overall annual BSI rate was 1.6/1,000 patient-days (range by year, 1.2-2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient-days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. No common source was identified for either of the outbreaks, but the NICU was overcrowded during the S. marcescens clusters. In both investigations, low birth we...

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Section: Postoperative Infection Ratessupporting

confidence: 91%

Section: Postoperative Infection Ratesmentioning

confidence: 69%

Section: Surgical Site Infectionsmentioning

confidence: 99%

Section: Characteristics Of Patients With Bloodstream Infectionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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314 Healthcare-Associated Infections in Pediatrics

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Bedside prediction rule for infections after pediatric cardiac surgery

et al. 2012

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PurposeInfections after pediatric cardiac surgery are a common complication, occurring in up to 30% of cases. The purpose of this study was to develop a bedside prediction rule to estimate the risk of a postoperative infection.MethodsAll consecutive pediatric cardiac surgery procedures between April 2006 and May 2009 were retrospectively analyzed. The primary outcome variable was any postoperative infection, as defined by the Center of Disease Control (2008). All variables known to the clinician at the bedside at 48 h post cardiac surgery were included in the primary analysis, and multivariable logistic regression was used to construct a prediction rule.ResultsA total of 412 procedures were included, of which 102 (25%) were followed by an infection. Most infections were surgical site infections (26% of all infections) and bloodstream infections (25%). Three variables proved to be most predictive of an infection: age less than 6 months, postoperative pediatric intensive care unit (PICU) stay longer than 48 h, and open sternum for longer than 48 h. Translation into prediction rule points yielded 1, 4, and 1 point for each variable, respectively. Patients with a score of 0 had 6.6% risk of an infection, whereas those with a maximal score of 6 had a risk of 57%. The area under the receiver operating characteristic curve was 0.78 (95% confidence interval 0.72–0.83).ConclusionsA simple bedside prediction rule designed for use at 48 h post cardiac surgery can discriminate between children at high and low risk for a subsequent infection.

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Nosocomial infections in infants and children after cardiac surgery

Hasija

Makhija

Kiran

et al. 2008

Indian J Thorac Cardiovasc Surg

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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)

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Nosocomial Infections in Pediatric Cardiac Surgery, Italy

Cited by 43 publications

References 24 publications

314 Healthcare-Associated Infections in Pediatrics

314 Healthcare-Associated Infections in Pediatrics

Bedside prediction rule for infections after pediatric cardiac surgery

Nosocomial infections in infants and children after cardiac surgery

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