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[Risk factors related to nosocomial pneumonia in pediatric patients undergoing heart surgery]
Rocío Elvira Fortanelli-Rodríguez1, Alejandro Gómez-Delgado, José Manuel Vera-Canelo
1Servicio de Infectología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México. guillermo.vazquezr@imss.gob.mx.
Insights
Hospital-acquired pneumonia is a risk after pediatric heart surgery. Longer surgery times and certain procedures increase risk, while procalcitonin levels may offer predictive value.
Area of Science:
- Pediatric Cardiac Surgery
- Infectious Disease Epidemiology
- Biomarker Research
Background:
- Procalcitonin aids in differentiating infections from non-infectious complications post-heart surgery.
- Understanding risk factors for nosocomial pneumonia is crucial in pediatric cardiac surgery patients.
- This study investigates risk factors and procalcitonin's predictive value for pneumonia in this population.
Purpose of the Study:
- To identify risk factors associated with nosocomial pneumonia in pediatric patients undergoing heart surgery.
- To evaluate the predictive value of serum procalcitonin levels for hospital-acquired pneumonia.
- To analyze the relationship between surgical events and pneumonia development.
Main Methods:
- A nested case-control study was conducted over one year in a tertiary hospital.
- Patients undergoing open-heart surgery were monitored daily for pneumonia development (CDC criteria).
- Serum procalcitonin levels were measured 48 hours post-surgery; cases had pneumonia, controls did not.
Main Results:
- 15% of 188 heart surgery patients developed pneumonia; 78% of cases occurred between postoperative days 2-5.
- Open sternotomy, reintubation, and surgical wound infections were more frequent in pneumonia cases.
- Control patients (no pneumonia) had longer surgery, bypass, cross-clamp times, and mechanical ventilation durations.
Conclusions:
- Specific surgical events and management strategies are significantly linked to hospital-acquired pneumonia development.
- Further research into procalcitonin's role in predicting pneumonia post-pediatric heart surgery is warranted.
- Identifying and mitigating these risk factors can improve outcomes for pediatric cardiac surgery patients.
Background:
Procalcitonin is a diagnostic marker useful to discern infections and non-infectious complications in heart surgeries. The aim is to describe risk factors related to nosocomial pneumonia and the predictive value of serum procalcitonin in pediatric patients undergoing heart surgery.
Methods:
During a year a nested case-control study was carried out in a third level hospital. All patients undergoing open-heart surgery were followed and clinical data searching for pneumonia were registered every day. Blood samples for determination of procalcitonin were taken 48 hours after surgery. Those patients who developed pneumonia based on CDC clinical criteria were defined as cases; and controls were those patients who did not developed pneumonia.
Results:
188 patients underwent heart surgery (15 % developed pneumonia). Ninety-seven patients were submitted to open-heart surgery: 24 cases and 73 controls. Seventy-eight % of cases developed pneumonia between second and fifth day after surgery. The average time of surgery, extracorporial bypass, aortic cross-clamp, and mechanical ventilation were greater in control patients. The frequency of open sternotomy, reintubation, and surgical wound infections was greater in case patients.
Conclusions:
Some of the events related to heart surgery and their subsequent management are associated significantly to the development of hospital-acquired pneumonia.
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