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Bacterial and fungal infections after cardiac surgery in children
Abstract:
Of 245 children operated on for congenital heart diseases in 1983-1984, bacterial and fungal infections occurred in 3.6% compared to 17.8% of 469 in 1968-1972. Staphylococcal infections decreased from 3.4%-0.8% and those by gram-negative bacteria from 6.9%-0%; Candida albicans infections increased from 0%-1.2%. Perioperative prophylaxis was performed with cefotaxime plus piperacillin in 1983-1984 versus oxacillin plus ampicillin in 1968-1972. It is argued that reduction of the infection rate is not only due to newer and more effective antibiotics but is mainly related to more advanced surgical techniques and improved hygiene in our intensive care units.
Insights
Infections in pediatric heart surgery patients significantly decreased from 17.8% to 3.6% between two periods. This reduction in bacterial and fungal infections is attributed to improved surgical techniques and hygiene, not solely antibiotics.
Area of Science:
- Pediatric Cardiac Surgery
- Infectious Disease Epidemiology
Background:
- Congenital heart disease surgeries carry a risk of post-operative infections.
- Historical data from 1968-1972 indicated a higher infection rate compared to more recent periods.
Purpose of the Study:
- To compare the incidence of bacterial and fungal infections in children undergoing congenital heart defect surgery between two distinct time periods.
- To evaluate the impact of evolving medical practices on post-operative infection rates.
Main Methods:
- Retrospective analysis of infection data from 469 children operated on between 1968-1972.
- Comparison with data from 245 children operated on between 1983-1984.
- Analysis of specific bacterial (Staphylococcal, gram-negative) and fungal (Candida albicans) infection rates.
- Review of perioperative antibiotic prophylaxis regimens used in both periods.
Main Results:
- Overall infection rates decreased from 17.8% (1968-1972) to 3.6% (1983-1984).
- Staphylococcal infections reduced from 3.4% to 0.8%.
- Gram-negative bacterial infections decreased from 6.9% to 0%.
- Candida albicans infections increased from 0% to 1.2%.
Conclusions:
- The significant reduction in post-operative infections is likely multifactorial.
- While newer antibiotics were used, advancements in surgical techniques and intensive care unit hygiene appear to be primary drivers of reduced infection rates.
- Ongoing surveillance for fungal infections is warranted.