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Surgical site infections and bloodstream infections in infants after cardiac surgery
Meghan T Murray1, Ganga Krishnamurthy1, Rozelle Corda2
1Department of Pediatrics, Columbia University Medical Center, New York, NY.
Insights
Surgical site infections (SSIs) and bloodstream infections (BSIs) are significant risks for infants undergoing cardiac surgery. Younger infants and specific surgical factors increase the risk of SSIs and BSIs, highlighting areas for improved patient safety.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Cardiovascular Surgery
Background:
- Surgical site infections (SSIs) and bloodstream infections (BSIs) are critical complications in infants following cardiac surgery.
- Limited recent data exists on the epidemiology and risk factors for these infections in this vulnerable population.
Purpose of the Study:
- To determine the incidence rates of SSIs and BSIs within three months of infant cardiac surgery.
- To identify risk factors associated with the development of SSIs and BSIs.
- To characterize the causative pathogens of these infections.
Main Methods:
- Retrospective cohort study of infants (<1 year) undergoing cardiac surgery (2010-2011).
- Analysis of infection rates, risk factors, and pathogens.
- Multivariable Cox proportional hazard modeling to assess risk factors for SSIs and BSIs.
Main Results:
- Overall complication rate of 8.7% for SSIs (3.4%) or BSIs (5.3%).
- Key predictors for SSIs included younger age (<30 days), incorrect antibiotic timing, and excessive bleeding.
- Arterial line duration was a significant predictor for BSIs.
- Gram-positive bacteria, particularly methicillin-susceptible Staphylococcus aureus, were the most common pathogens.
Conclusions:
- SSIs and BSIs represent significant challenges in infant cardiac surgery.
- Strategies to mitigate risk include optimizing antimicrobial prophylaxis timing, improving hemostasis, and early arterial line removal.
Objective:
Few recent studies have assessed the epidemiology of and risk factors for surgical site infections (SSIs) and bloodstream infections (BSIs) in infants after cardiac surgery. We hypothesized that infants younger than 30 days old and those with higher Risk Adjustment in Congenital Heart Surgery-1 scores would have an increased risk of SSIs, but not an increased risk of BSIs after surgery.
Methods:
We performed a retrospective cohort study of infants younger than 1 year of age undergoing cardiac surgery from January 2010 to December 2011 to determine the rates of SSIs and BSIs occurring within 3 months of surgery, risk factors associated with these infections, and causative pathogens. Multivariable associations using Cox proportional hazard modeling assessed potential risk factors for BSIs or SSIs.
Results:
Overall, 8.7% (48 of 552) of surgical procedures were complicated by SSIs (n = 19) or BSIs (n = 29). Thus, SSIs and BSIs occurred after 3.4% and 5.3% of procedures, respectively. Multivariate models found age younger than 30 days, incorrect timing of preoperative antibiotics, and excessive bleeding within 24 hours of surgery to be significant predictors for SSIs, and duration of use of arterial lines to be a significant predictor for BSIs. Gram-positive bacteria caused 75% of SSIs and BSIs and methicillin-susceptible Staphylococcus aureus caused 63% of SSIs.
Discussion:
We identified some potential strategies to reduce risk, including closer monitoring of timing of preoperative antimicrobial prophylaxis and enhanced efforts to achieve intraoperative hemostasis and earlier removal of arterial lines.
Conclusions:
SSIs and BSIs remain important complications after cardiac surgery in infants.
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