[Nosocomial infections in pediatric patients following cardiac surgery]

Nosocomial infection (NI) is a possible complication in patients who undergo cardiac surgery, and represents an important cause of morbidity and mortality. This study was undertaken to determine the NI rate, main risk factors, and microbial spectrum in a paediatric intensive care unit (PICU) for this group of patients.

A prospective review was performed, including all patients admitted to the PICU after cardiac surgery between December 2003 and November 2004. NI was defined according to Centers for Disease Control criteria.

Sixty-nine patients were included. Sixteen patients (23.2 %) acquired at least one episode of NI. The NI rate was 4.9 per 100 patient-days. The most common NI was pneumonia, followed by urinary tract infection. There were no episodes of sepsis. No patients died from infectious causes. The main aetiological organism was Haemophilus influenzae, associated with 41.6 % of pneumonias, and followed by Pseudomonas aeruginosa. No multiresistant organisms were isolated. There was a statistically significant association between the duration of use of external devices (mechanical ventilation, urinary and central venous catheterization) and development of NI.

Aggressive monitoring and support devices are the main risk factors for NI. Based on our data, we suggest early removal of these. Presumed NI should be diagnosed according standard criteria before starting antibiotic therapy, and treatment modified depending on culture results.