Preoperative colonization in pediatric cardiac surgery and its impact on postoperative infections

Silvetti, Simona; Ranucci, Marco; Isgrò, Giuseppe; Villa, Valentina; Costa, Elena

doi:10.1111/pan.13169

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Аналогично результатам данного исследования, ведущими колонизирующими микроорганизмами были «проблемные» грамотрицательные бактерии (проду центы БЛРС и карбапенемаз). Авторами не было выяв лено статистически значимых различий в частоте раз вития послеоперационных инфекционных осложнений у колонизированных и неколонизированных пациен тов, при этом носители в среднем на 2 дня дольше пре бывали в стационаре перед операцией (95% ДИ 0,3-3,8 дня, р = 0,021) [13].…”

Section: Discussionunclassified

Carriage of antibiotic-resistant bacteria and etiology of postoperative infectious complications in infants with congenital heart defects

Попов

Votrikova

Rogova

et al. 2022

CMAC

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Objective. To determine resistant microorganisms carriage, the frequency and etiology of postoperative infectious complications in high-risk infants with congenital heart defects (CHD). Materials and Methods. The retrospective analysis included 489 patients admitted for surgical treatment for CHD. The median age was 0.23 (0–12) months. Swabs were taken from the oropharynx and rectum for microbiological examination no later than 72 hours after admission (a total of 978 samples). The growth of resistant microorganisms (ESBL and/or carbapenemase-producing Enterobacterales, resistant non-fermentative Gram-negative bacteria, MRSA and VRE) was recorded. Results. Of 489 patients, 128 (26.2%) were colonized with resistant bacteria. The majority of patients were carriers of ESBL-producers (81.3%), in some cases (24%) with concomitant production of several carbapenemases. The rate of VRE carriage was 21.1%, in 8 cases – in combination with other resistant microorganisms. MRSA was detected in 1.6% of carriers, other multidrug-resistant microorganisms – in 3.9% of carriers. In early postoperative period, 145⁄489 (29.7%) patients developed infectious complications. The ventilator-associated respiratory tract infections were the most common. In most cases (73.8%) infectious complications were caused by ESBL producers, in 43.9% of cases those microorganisms also produced carbapenemases. Resistant non-fermentative Gram-negative bacteria caused postoperative infections in 4.8% of cases. The rates of MRSA and VRE in infants with infectious complications were 3.4% and 1.4%, respectively. There were no differences in the incidence of infectious complications in colonized and non-colonized patients – 42⁄128 (32.8%) versus 103⁄361 (28.5%), respectively (p = 0.6). Postoperative infectious complications were caused by resistant microorganisms in colonized patients significantly more often than in non-colonized patients – 41⁄42 (97.6%) and 82⁄103 (79.6%) cases, respectively (p = 0.008). Conclusions. It is confirmed the active process of the introduction of resistant microorganisms into the hospital with the possible development of complications of the corresponding etiology. Gram-negative bacteria with different mechanisms of antibiotic resistance present the greatest problem. In order to manage this process, it is advisable to screen hospitalizing patients with the implementation of the infection control measures.

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Section: Discussionunclassified

Carriage of antibiotic-resistant bacteria and etiology of postoperative infectious complications in infants with congenital heart defects

Попов

Votrikova

Rogova

et al. 2022

CMAC

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“…Specific solutions for the disinfection of the surgical wound are listed in these documents provided by the interviewed CICUs: the povidone-iodine solution (the most commonly used), chlorhexidine, hydrogen peroxide, and Amuchina. Although in the literature there are no precise indications about the most appropriate solution for the disinfection of the surgical wound [14], detailed prophylaxis exists that specify pre-and intra-operative recommendations [2,7,9,12,15]. Regarding the antibiotic prophylaxis, Bath et al (2016) demonstrated that limiting antimicrobial prophylaxis to 48 h after pediatric cardiac surgery neither increase the incidence of SSIs nor alter other clinical outcomes in this population.…”

Section: Discussionmentioning

confidence: 99%

“…Another fundamental aspect that deserves further studies is to establish the best timing for administering pre-operative antibiotics and antiseptic skin preparation [7,8]. Some studies suggest the use of the pre-operative nasal culture [6,[15][16][17][18]. However, further studies are needed in order to analyze this association.…”

Section: Discussionmentioning

confidence: 99%

Survey on Sternal Wound Management in the Italian Pediatric Cardiac Intensive Care Units

Prendin¹,

Tabacco²,

Fazio

et al. 2021

Healthcare

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(1) Background: a review of the literature found a lack of standardized pediatric guidelines regarding wound management after cardiac surgery. (2) Objective: the aim of the study is to investigate the cardiac surgical wound management in Italian pediatric cardiac intensive care units. (3) Methods: we sent an online questionnaire to the 13 Italian pediatric cardiac intensive care units. (4) Results: ten pediatric cardiac intensive care units (77%) have a protocol for the management of the cardiac surgical wound. The staff members that mainly have the responsibility for the wound management after cardiac surgery are registered nurses and physicians together both in the pediatric cardiac intensive care units (69%), and when a patient is transferred to another ward (62%). Thirty-eight percent of the pediatric cardiac intensive care units have a protocol used to monitor wound infection, and the staff mostly uses a written shift report (54%) to monitor the infection. (5) Discussion: this is the first survey to investigate the management of the wound after cardiac surgery in Italian pediatric cardiac intensive care units. The small sample size and the fact that the centers involved are only Italian cardiac intensive care units are the limits of this study. (6) Conclusions: in the Italian pediatric cardiac intensive care units it emerged that there is a diversity in the treatments adopted and a lack of specific protocols in the management of the pediatric cardiac surgical wound.

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“…Preoperative S. aureus decolonization is not routinely recommended for most pediatric patients undergoing surgery, however the impact of preoperative colonization on risk of SSI in children has been examined in many small studies. Risk of SSI was not elevated in S. aureus-colonized children undergoing cardiac surgery [98]. Studies in adult cardiac surgery patients, however, suggest a benefit to mupirocinbased decolonization in prevention of SSI [99]; this topic as it pertains to cardiac surgery is discussed further in Chap.…”

Section: Ast Isolation and Targeted Decolonization Using Mupirocinmentioning

confidence: 98%

The Role of the Environment and Colonization in Healthcare-Associated Infections

Wohrley

Bartlett

2018

Healthcare-Associated Infections in Children

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Colonization is the survival of a microorganism on an internal (gastrointestinal, respiratory, or genitourinary tract) or external (skin) surface of the host without causing disease. Different types of organisms colonize different surfaces. For example, skin and the mucous membranes of the nose may be colonized with gram-positive organisms, including Staphylococcus aureus and coagulase-negative staphylococci [1]. The pharynx is colonized with gram-positive and gram-negative organisms including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis [2]. Gram-negative aerobic and anaerobic organisms commonly found colonizing the gastrointestinal tract include gram-negative aerobic and anaerobic bacteria and gram-positive organisms including Enterococcus and C. difficile.Hosts encounter microbes on a nearly constant basis from the environment around them. A patient's own colonizing flora can result in hospital-associated infections when host defenses are compromised by underlying disease, immune compromise, or invasive devices. Alternatively, the healthcare environment can provide a source of pathogens, either by indirect transmission on the hands of healthcare workers (HCWs) or by direct transfer from environmental contamination.The outcome of human-microbe interactions depends on the complex interplay of host defenses against microbial invasion and microbial virulence factors. If microbes are not killed by the immune system, a commensal relationship between the colonizer and the host may develop; alternatively, this may be the first step in the process of infection, damaging the host as a result of multiplication of the microorganism. Prolonged illness leading to immunodeficiency and breaks in barriers

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Preoperative colonization in pediatric cardiac surgery and its impact on postoperative infections

Abstract: The results of our study suggest that the impact of preoperative colonization on outcome and postoperative infections may be negligible; larger series are required to clearly define this issue.

Cited by 6 publications

References 17 publications

Carriage of antibiotic-resistant bacteria and etiology of postoperative infectious complications in infants with congenital heart defects

Carriage of antibiotic-resistant bacteria and etiology of postoperative infectious complications in infants with congenital heart defects

Survey on Sternal Wound Management in the Italian Pediatric Cardiac Intensive Care Units

The Role of the Environment and Colonization in Healthcare-Associated Infections

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