Targeted Multidrug Resistant Organism Antimicrobial Prophylaxis and Postoperative Infections in Pediatric Cardiothoracic Surgical Patients
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Published on: June 2, 2022
Jeffrey J Cies1,2,3, Christina Palladino1, Hera Mahmood1
1From the Department of Pharmacy, Department of Pediatrics, Section of Critical Care Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
Background:
To determine if receiving targeted antimicrobial (AM) prophylaxis has an effect on the rate of postoperative infections in patient's colonized with a multidrug resistant organism (MDRO) undergoing cardiothoracic surgery (CTS).
Methods:
Single-center, retrospective medical record review of pediatric patients from birth to 18 years of age undergoing CTS from January 2013 to September 2018. Demographic data collected included age, specific MDRO, site of MDRO colonization, type of surgery, perioperative AM agent and type of infection. Patients were stratified into 2 groups, MDRO+ and MDRO-. Demographic and clinical characteristics were compared between groups with a Student's t test for continuous variables and a χ2, Fisher exact test or Mann-Whitney U test for noncontinuous variables. A 2-sided significance level of α = 0.05 was used to determine statistical significance. All analyses were performed using IBM SPSS Version 24 (SPSS Inc., Chicago, IL).
Results:
Fifty patients (26 males/24 females) were included in the MDRO (+) group and 295 patients (168 males/127 females) in the MDRO (-) group. The median age was 0.48 years (interquartile range 0.24-1 year) and 0.9 years (interquartile range 0.19-8 years) in the MDRO (+) and MDRO (-) groups, P = 0.003. 2 of 50 (4%) MDRO (+) patients and 15 of 295 (5.1 %) MDRO (-) patients developed an infection, P = 1. 10 of 50 (20%) MDRO (+) patients received targeted AM toward the MDRO and none developed an infection. Of the 2 MDRO (+) patients with infection, 1 was infected with the MDRO. For MDRO (+) patients, there was no difference in the rate of infection whether targeted AM therapy was received, P = 1.
Conclusions:
There was no difference in the rate of postoperative infection between MDRO (+) and MDRO (-) patients. Additionally, these preliminary pediatric data suggest targeting AM agents to a specific MDRO does not impact the rate of postoperative infection in children undergoing CTS. Larger studies are warranted to confirm these findings.
Insights
Targeted antimicrobial prophylaxis did not reduce postoperative infections in pediatric patients colonized with multidrug-resistant organisms (MDROs) undergoing cardiothoracic surgery (CTS). Further research is needed to confirm these findings in pediatric populations.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Postoperative infections are a concern in patients undergoing cardiothoracic surgery (CTS).
- Multidrug-resistant organisms (MDROs) pose a significant challenge in healthcare settings.
- The efficacy of targeted antimicrobial prophylaxis in MDRO-colonized patients undergoing CTS is not well-established.
Purpose of the Study:
- To investigate the effect of targeted antimicrobial (AM) prophylaxis on postoperative infection rates.
- To compare infection rates in pediatric patients colonized with MDROs versus those not colonized.
- To evaluate if specific AM agents targeting MDROs impact infection rates in this population.
Main Methods:
- Retrospective review of medical records for pediatric patients (0-18 years) undergoing CTS.
- Stratification of patients into MDRO-colonized (MDRO+) and non-colonized (MDRO-) groups.
- Comparison of demographic and clinical characteristics, including AM use and infection development, using statistical tests (t-test, chi-squared, Fisher exact, Mann-Whitney U).
Main Results:
- No significant difference in postoperative infection rates between MDRO+ (4%) and MDRO- (5.1%) patients.
- Among MDRO+ patients, targeted AM prophylaxis was administered to 20%, with none developing infection.
- However, no difference in infection rates was observed in MDRO+ patients regardless of whether targeted AM therapy was received.
Conclusions:
- Postoperative infection rates were similar between pediatric cardiothoracic surgery patients with and without MDRO colonization.
- Targeting antimicrobial agents to specific MDROs did not appear to reduce postoperative infection rates in this pediatric cohort.
- Larger studies are recommended to validate these preliminary findings.
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