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Preventive strategies in paediatric cardiovascular surgery: impact on surgical site infections and beyond
A M Montoya1, G E Roncancio2, L Franco1
1Department of Microbiology, Clínica Cardio VID, Medellín, Colombia.
Insights
Healthcare-associated infections (HAIs) are a risk in pediatric cardiovascular surgery. While preventive strategies reduced surgical site infections (SSIs), other HAIs remain a challenge, requiring targeted interventions.
Area of Science:
- Pediatric Cardiovascular Surgery
- Infectious Disease Epidemiology
- Public Health
Background:
- Global increase in surgical management for congenital heart disease (CHD).
- Healthcare-associated infections (HAIs) pose a significant threat to surgical outcomes.
- Need for effective infection control in pediatric cardiovascular surgery programs.
Purpose of the Study:
- Analyze HAI incidence in a pediatric cardiovascular surgery program.
- Evaluate the impact of implemented preventive interventions.
- Characterize microbiological profiles of HAIs.
Main Methods:
- Retrospective cohort study of children (<12 years) with CHD undergoing cardiovascular surgery (2010-2021).
- Data collection from medical records, laboratory results, and infection control databases.
- Poisson regression model used to assess the impact of interventions on HAI rates.
Main Results:
- 2512 surgeries analyzed; SSI incidence decreased from 9.5% to 3.0% (P=0.030).
- Specific interventions like weight-based antibiotic prophylaxis and vacuum-assisted closure (VAC) showed significant SSI reduction.
- No significant reduction observed for central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), or ventilator-associated pneumonia (VAP).
Conclusions:
- Targeted preventive strategies can effectively reduce surgical site infections (SSIs) in pediatric cardiovascular surgery.
- Broader spectrum of HAIs, including CLABSI, CAUTI, and VAP, require distinct and focused intervention strategies.
- Emphasis on developing tailored approaches to mitigate diverse HAIs in this vulnerable population.
Background:
Surgical management of congenital heart disease (CHD) has increased worldwide, but healthcare-associated infections (HAIs) can threaten these efforts.
Aim:
To analyse the incidence of HAI, the impact of preventive interventions, and microbiological profiles in a paediatric cardiovascular surgery programme.
Methods:
Cohort study including children aged <12 years with CHD who underwent cardiovascular surgery between 2010 and 2021 in Medellín, Colombia (a middle-income setting). Data were collected from medical and laboratory records and infection control programme databases. Impact of various preventive interventions was assessed using a Poisson model. P < 0.05 was considered statistically significant.
Findings:
A total of 2512 surgeries were analysed. Incidence of surgical site infection (SSI) was 5.9%, followed by central line-associated bloodstream infection (CLABSI; 4.7%), catheter-associated urinary tract infection (CAUTI; 2.2%), and ventilator-associated pneumonia (VAP; 1.4%). Most of the strategies focused on preventing SSI, resulting in a reduction from 9.5% in 2010 to 3.0% in 2021 (P = 0.030). Antibiotic prophylaxis based on patient weight and continuous infusion had an impact on reducing SSI (RR: 0.56; 95% CI: 0.32-0.99). Vacuum-assisted closure (VAC) in clean wounds reduced 100% of infections. No significant risk reduction was observed for other HAI with the implemented interventions.
Conclusion:
Preventive strategies effectively reduced SSI but no other infections, emphasizing the need for targeted approaches to address a broader spectrum of HAI successfully.
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