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Preoperative colonization in pediatric cardiac surgery and its impact on postoperative infections
Simona Silvetti1, Marco Ranucci1, Giuseppe Isgrò1
1Department of CardioVascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Piazza Edmondo Malan, Milan, Italy.
Insights
Preoperative pathogen colonization in pediatric cardiac surgery patients did not increase postoperative infections. However, colonized patients experienced longer hospital stays before surgery, suggesting screening may be beneficial.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Surgical Outcomes
Background:
- Patients with congenital heart defects (CHDs) face high risks of pathogen colonization due to frequent hospitalizations before surgery.
- Limited data exists on colonization prevalence and its impact on postoperative infections in pediatric cardiac surgery patients.
Purpose of the Study:
- To investigate the effect of preoperative pathogen colonization on postoperative infections in pediatric cardiac surgery patients.
- To compare colonization rates and outcomes between Italian and foreign patients undergoing cardiac surgery.
Main Methods:
- Retrospective study of pediatric patients (≤18 years) undergoing open-heart surgery in 2015.
- Analysis of clinical data and swab culture results to assess pathogen colonization.
- Statistical analysis to determine the association between colonization and postoperative infections, length of stay, and other outcomes.
Main Results:
- 50% of screened pediatric cardiac surgery patients (n=169) had at least one positive swab for pathogen colonization.
- Italian patients showed significantly lower colonization rates compared to foreign patients (RR 0.17).
- Postoperative infection rates were similar between colonized and non-colonized patients (RR 1.24).
- Colonized patients had a significantly longer preoperative hospital stay (mean difference 2 days).
Conclusions:
- Preoperative pathogen colonization appears to have a negligible impact on postoperative infections in pediatric cardiac surgery.
- Further research with larger patient cohorts is needed to definitively establish the role of colonization in outcomes.
- Findings suggest potential benefits of preoperative screening for optimizing hospital stay duration.
Background:
Patients with congenital heart defects are frequently hospitalized before surgery. This exposes them to a high risk for pathogen colonization. There are limited data on colonization prevalence in the pediatric cardiac population, and limited data concerning its potential role in the risk of developing infections after cardiac surgery.
Aim:
This study aimed to verify the impact of preoperative colonization on postoperative infections in a population of pediatric cardiac surgery patients coming from Italy and developing countries.
Methods:
This was a retrospective study conducted in all the patients aged ≤18 years who underwent pediatric open-heart surgery in the year 2015. Clinical data were retrieved from the institutional database for cardiac surgery patients. Data on swab cultures were retrieved from the laboratory database. Swab colonization was tested for association with infection and other outcomes.
Results:
Among 169 children who performed the screening for pathogen colonization, 50% had at least one positive swab. Italian patients were (P=.001) less likely to be colonized with respect to foreign patients (relative risk 0.17, 95% CI 0.09-0.35). Postoperative infections in colonized patients occurred at a similar rate as in noncolonized patients (relative risk 1.24, 95% CI 0.64-2.39; P=.532). Colonized patients had a preoperative stay (P=.021) longer than noncolonized patients (mean difference 2 days, 95% CI 0.3-3.8 days).
Conclusion:
The results of our study suggest that the impact of preoperative colonization on outcome and postoperative infections may be negligible; larger series are required to clearly define this issue.
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