Postoperative nosocomial infections among children with congenital heart disease

Abstract

Objective: To study the pathogen distribution, antimicrobial susceptibility and risk factors of postoperative nosocomial infections among children with congenital heart disease. Methods: Three hundreds children with congenital heart disease admitted to our hospital to receive surgeries from February 2010 to February 2013 were selected. Results: A total of 120 children were tested as positive by sputum culture, with the infection rate of 40.0%. The top five most common pathogenic microorganisms included Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus, Pseudomonas aeruginosa, and Candida albicans. S. epidermidis, S. aureus and Enterococcus were highly resistant to penicillin, azithromycin and erythromycin, moderately susceptible to levofloxacin and cefazolin, and completely susceptible to vancomycin. Multivariate Logistic regression analysis showed that hospitalization stay length, combined use of antibiotics, systemic use of hormones, mechanical ventilation and catheter indwelling were the independent risk factors of postoperative nosocomial infections (P<0.05). Conclusion: Nosocomial infection, which was the most frequent postoperative complication of pediatric congenital heart disease, was predominantly induced by Gram-positive bacteria that were highly susceptible to cephalosporins and vancomycin. Particular attention should be paid to decrease relevant risk factors to improve the prognosis.

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

“…Surgery is the main treatment for most heart defects [14]. But pediatric cardiac surgery reduces the patient's immunity and increases the risk of postoperative infection [15]. The study found that nosocomial infection was one of the main complications in the postoperative period in children with CHD, and are major causes of morbidity and mortality after cardiac surgery [16].…”

Perioperative infections in congenital heart disease

“…Risk factors for ventilator-associated pneumonia were PRISM III score > 10 and transfusion of fresh-frozen plasma. 12 Epidemiology of perioperative infections in low-and middle-income countries Among 21 studies in low-and middle-income countries, four were conducted in China, [43][44][45][46] four in India, [47][48][49][50] three in Brazil, [51][52][53] two in Saudi Arabia 54,55 , and one each in Argentina, 56 Bosnia Herzegovina, 57 Iran, 58 Ethiopia, 59 Guatemala, 60 and Sudan. 61 One multicentre study involving 17 low-to middle-income countries included India, Pakistan, Colombia, Russia, China, Dominican Republic, Brazil, Argentina, El Salvador, Ukraine, Peru, Mexico, Belarus, Vietnam, Uganda, Guatemala, and Bangladesh.…”

“…62 There were five different study designs including one randomised controlled trial, 53 one non-randomised interventional before-after study, 62 16 cohort studies, [43][44][45][47][48][49][50]52,[54][55][56][57]59,60,63 one case-control study, 51 and three cross-sectional studies. 46,58,61 Most studies were conducted in children, with two in neonates 47,57 and two involving children and adult patients. 43,50 Preoperative infection There were seven studies evaluating preoperative infections among children with CHD in low-to middle-income country settings.…”

“…Among studies evaluating postoperative infections, the prevalence of infection was varied ranging from 7.8% of 203 children in Iran to 40% of 300 children in China. 46,58 Microbes isolated from children with postoperative infection were 66.6% Gram-positive and 26.7% Gram-negative bacteria, and 6.7% were fungi. The most common pathogens were Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus spp, Pseudomonas aeruginosa, and Candida albicans.…”

“…The most common pathogens were Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus spp, Pseudomonas aeruginosa, and Candida albicans. 46 Risk factors for postoperative infections were length of hospital stay, use of combined antibiotics, use of hormone therapy, mechanical ventilation, and indwelling central venous catheter. 46 The incidence of postoperative sepsis or bloodstream infection across 17 countries was 7% of 15,049 in children, and 21% (17/330) in neonates, after cardiac surgery.…”