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[Incidence and risk factors associated with nosocomial infection in pediatric heart surgery]
Fidencia Duarte-Raya1, Fabiola Janet Baeza-Zarco
1Unidad Médica de Alta Especialidad 48, Hospital de Gineco-Pediatría, Instituto Mexicano del Seguro Social, León, Guanajuato, México. fidencia.duarte@imss.gob.mx.
Insights
Pediatric heart surgery patients face high risks of nosocomial infections, particularly those with congenital heart defects. Mechanical ventilation and nasogastric tubes significantly increase infection risk, leading to higher mortality rates.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Cardiovascular surgery outcomes
Background:
- Nosocomial infections (hospital-acquired infections) are a major cause of illness and death in children after heart surgery.
- Understanding the incidence and risk factors for these infections is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of nosocomial infections in pediatric heart surgery patients.
- To identify associated risk factors contributing to these infections.
Main Methods:
- A prospective, descriptive clinical study was conducted over one year in a tertiary hospital.
- Statistical analysis included incidence and cumulative incidence rates, odds ratios, and microbial identification with antibiotic sensitivity testing.
- EPIDAT 2004 software was used for statistical calculations, including Chi-square tests and confidence intervals.
Main Results:
- The incidence of nosocomial infections was 45%, with a cumulative incidence of 80.6%.
- Pneumonia was the most common infection (44.4%), frequently associated with mechanical ventilation (74%) and nasogastric tubes (100%).
- Key pathogens included Acinetobacter baumanni, Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa, exhibiting high antibiotic resistance.
Conclusions:
- Pediatric heart surgery patients, especially those with cyanotic heart disease, have a significantly elevated risk of infection.
- Use of nasogastric and endotracheal tubes, along with prolonged hospital stays, are statistically associated with increased infection risk.
- Infected patients face a fourfold higher risk of death compared to non-infected patients.
Background:
Nosocomial infections are responsible for a high rate of morbidity and mortality in pediatric patients undergoing heart surgery. Our objective was to determine the incidence and associated risk factors to nosocomial infections in this group of patients.
Methods:
A descriptive, prospective, clinical study was conducted in a tertiary hospital for a year. We calculated the rate of incidence, accumulated incidence and devices used. Was Applied the EPIDAT 2004 version 3.1 program OPS for obtaining of Chi-square with Yates correction for p with a confidence of 95 %, alpha of 0.05 with a degree of freedom, we calculated odds ratio, besides of the identification of microorganisms, their sensitivity and resistance to antibiotics.
Results:
We calculated rates of: 45 % the incidence, 80.6 % cumulative incidence, 7.4 % of mortality, 13.3 % of case-fatality rate of infected and 2.7 % non-infected. The 44.4 % with pneumonia, 74 % associated with mechanical ventilation, 100 % nasogastric tube. The most frequently isolated microorganisms are: Acinetobacter baumanni, Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa with high resistance to antibiotics.
Conclusions:
Pediatric patients undergoing heart surgery have high risk of infection heart disease, cyanogen's have 5 times more risk. We observed a statistically significant association with infection using nasogastric probe and endotracheal tube, the risk increases to increased hospital stay. Infected patients have 4 times the risk of death.
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