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Early nosocomial infections in pediatric cardiovascular surgery patients
E M Pollock1, E L Ford-Jones, I Rebeyka
1Department of Intensive Care Medicine, University of Toronto, ON, Canada.
Insights
Cardiovascular surgery patients experienced infections, with wound infections more common when sternums remained open or PRISM scores were high. Staphylococcus aureus and CONS were primary wound infection culprits.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pediatric Surgery
Background:
- Nosocomial infections pose a significant risk to patients undergoing cardiovascular surgery.
- Understanding infection patterns is crucial for improving patient outcomes in pediatric intensive care units (PICUs).
Purpose of the Study:
- To investigate the incidence and risk factors of nosocomial infections, particularly wound infections, in pediatric patients following cardiovascular surgery.
- To identify specific surgical and patient-related factors associated with increased infection risk.
Main Methods:
- A retrospective study followed 310 patients undergoing cardiovascular surgery from July 1987 to February 1988.
- Data collected included surgical procedure type, Pediatric Risk of Mortality (PRISM) score on admission, and development of nosocomial infections.
- Infection types, causative agents, and associated risk factors were analyzed.
Main Results:
- 40 patients (12.9%) developed 78 infections (25.2 per 100 patients), with 22 (28%) being wound infections.
- Wound infections were significantly more likely in patients with an open sternum on the ward (27.6%) compared to closed (5.0%), and in those with a PRISM score >= 10 (10.7%) versus < 10 (2.3%).
- Staphylococcus aureus and coagulase-negative staphylococci (CONS) were common in closed cases; CONS, Pseudomonas aeruginosa, and Candida spp. were prevalent in open cases.
Conclusions:
- Leaving the sternum open post-surgery, high PRISM scores, and specific surgical procedures are significant risk factors for wound infections in pediatric cardiovascular surgery patients.
- Non-wound infections, including bacteremias and line-related infections, were also common.
- Targeted interventions focusing on sternal wound care and patient risk stratification are essential for reducing infection rates.
Abstract:
All patients undergoing cardiovascular surgery between July 1, 1987 and February 29, 1988 were followed from admission to the pediatric ICU (PICU) daily by an intensivist/anesthetist. Patients were characterized by surgical procedure and PRISM score on ICU admission. Of 310 patients, 40 patients (nosocomially infected patient ratio 12.9) developed 78 infections (nosocomial infection ratio 25.2), of which 28% (n = 22) were wounds, within 2 months of surgery. Early wound infection followed 8% of closed, nonpump cases and 6.7% of open, pump cases. Wound infection was more likely if the sternum was open on the ward (elective or emergency) (27.6% open vs. 5.0% closed, p less than .001) or if the PRISM score was greater than or equal to 10 on PICU admission (10.7% greater than or equal to 10 vs. 2.3% less than 10, p less than .01). The causative agents in wound infections in closed cases were Staphylococcus aureus (70%) and coagulase negative staphylococci (CONS) (30%) while in open, pump cases the agents were CONS (33%), Pseudomonas aeruginosa (27%), Candida spp. (27%), and S. aureus (20%). Nonwound infections accounted for 72% of infections (n = 56). The number of bacteremias and other central and arterial line-related infections approximated wound infection in incidence at 6.8/100 patients. Wound infections are more likely if the sternum has been left open on the ward, if the patient has a high PRISM score on PICU admission, and after specific surgical procedures.