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Nosocomial Infections in Pediatric Cardiac Surgery, Italy

Published online by Cambridge University Press:  02 January 2015

Mariangela Valera ,
Carlo Scolfaro ,
Nazario Cappello ,
Elena Gramaglia ,
Sergio Grassitelli ,
Maria Teresa Abbate ,
Alberta Rizzo ,
Piero Abbruzzese ,
Andrea Valori  and
Stefano Longo
...Show all authors
Mariangela Valera
Affiliation:
Department of Immuno-Infectivology, Regina Margherita Children's Hospital, Turin, Italy
Carlo Scolfaro
Affiliation:
Department of Immuno-Infectivology, Regina Margherita Children's Hospital, Turin, Italy
Nazario Cappello
Affiliation:
Department of Genetics and Biochemistry, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
Elena Gramaglia
Affiliation:
Department of Immuno-Infectivology, Regina Margherita Children's Hospital, Turin, Italy
Sergio Grassitelli
Affiliation:
Cardiac Intensive Care Unit, Regina Margherita Children's Hospital, Turin, Italy
Maria Teresa Abbate
Affiliation:
Cardiac Intensive Care Unit, Regina Margherita Children's Hospital, Turin, Italy
Alberta Rizzo
Affiliation:
Cardiac Intensive Care Unit, Regina Margherita Children's Hospital, Turin, Italy
Piero Abbruzzese
Affiliation:
Cardiac Surgery, Regina Margherita Children's Hospital, Turin, Italy
Andrea Valori
Affiliation:
Cardiac Surgery, Regina Margherita Children's Hospital, Turin, Italy
Stefano Longo
Affiliation:
Cardiac Surgery, Regina Margherita Children's Hospital, Turin, Italy
Pier Angelo Tovo*
Affiliation:
Department of Immuno-Infectivology, Regina Margherita Children's Hospital, Turin, Italy
*
Department of Immuno-Infectivology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10156 Turin, Italy
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Abstract

Objective:

To evaluate the incidence of nosocomial infection (NI) in pediatric patients who received cardiothoracic surgery and to identify possible associated risk factors.

Design:

Prospective observational study.

Setting:

The cardiac surgery and cardiac intensive care units at the Regina Margherita Children's Hospital, Turin, Italy.

Patients:

All patients who underwent surgery from July 20,1998, to July 19,1999, were enrolled, except patients with operative catheterization only.

Methods:

Clinical data were collected daily from July 20, 1998, to July 19, 1999. NIs were diagnosed according to US Centers for Disease Control and Prevention criteria.

Results:

104 patients were included in the present study, 80 (76.9%) of whom underwent extracorporeal circulation. The NI ratio was 48.1% (50/104); the percentage of patients with NI was 30.8% (32/104): 23.1% developed one infection, 7.7% two or more. The rate of NI was 2.17 per 100 days of hospitalization (50/2,304). The most common pathogen was Pseudomonas aeruginosa, Important risk factors were length of preoperative admission >5 days, total length of admission >10 days, open chest during postoperative phase, and cyanotic heart disease. There was a significant association between sepsis and central venous catheterization for 3 days or more. Rate of sepsis was 19 per 1,000 catheter days (16/852).

Conclusion:

NIs represent a frequent complication for children who undergo heart surgery. Based on our data, we suggest decreasing the preoperative stay as much as possible. The higher NI incidence in patients with an open chest postoperatively suggests that an alternative antibiotic strategy should be considered for these patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 12 , December 2001 , pp. 771 - 775
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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References

1. Moro, ML, Stazi, MA, Marasca, G, Greco, D, Zampieri, A. A national prevalence survey of hospital-acquired infections in Italy, 1983. J Hosp Infect 1986;8:72–85.CrossRefGoogle ScholarPubMed
2. Kollef, MH, Sharpless, L, Vlasnik, J, Pasque, C, Murphy, D, Fraser, VJ. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 1997;112:666–675.CrossRefGoogle ScholarPubMed
3. DeRiso, AJ 2nd, Ladowski, JS, Dillon, TA, Justice, JW, Peterson, AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996;109:1556–1561.CrossRefGoogle ScholarPubMed
4. Niederhauser, U, Vogt, M, Vogt, P, Genoni, M, Kunzkli, A, Turina, MI. Cardiac surgery in a high-risk group of patients: is prolonged postoperative antibiotic prophylaxis effective? J Thorac Cardiovasc Surg 1997;114:162–168.CrossRefGoogle Scholar
5. Schiavini, M, Orlando, G, Casella, A, Santoli, E, Munari, M, Savi, C, et al. Nosocomial infections following cardiosurgery: analysis of risk factor [in Italian]. Giornale Italiano delle Infezioni Ospedaliere 1998;5:64–68.Google Scholar
6. Firor, WB. Infection following open-heart surgery, with special reference to the role of prophylactic antibiotics. J Thorac Cardiovasc Surg 1967;53:371–377.CrossRefGoogle Scholar
7. Rebollo, MH, Bernal, JM, Llorca, J, Rabasa, JM, Revuelta, JM. Nosocomial infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg 1996;112:908–913.CrossRefGoogle ScholarPubMed
8. Pollock, EM, Ford-Jones, L, Rebeyka, I, Mindorff, CM, Bohn, DJ, Edmunds, JF, et al. Early nosocomial infections in pediatric cardiovascular surgery patients. Crit Care Med 1990;18:378–384.CrossRefGoogle ScholarPubMed
9. Dagan, O, Cox, PN, Ford-Jones, L, Ponsonby, J, Bonh, DJ. Nosocomial infections following cardiovascular surgery: comparison of two periods, 1987 vs 1982. Crit Care Med 1999;27:104–108.CrossRefGoogle Scholar
10. Mantero, E, Panizzon, G, Tacchella, A, Rovida, S, Fabbri, A, Calza, G, et al. Occurrence of hospital infections in a department of pediatric heart surgery [in Italian]. Pediatr Med Chir 1986;8:715–720.Google Scholar
11. Fisher, MC, Long, SS, Roberts, EM, Dunn, JM, Balsara, RK. Pseudomonas maltophilia bacteremia in children undergoing open heart surgery. JAMA 1981;246:1571–1574.CrossRefGoogle ScholarPubMed
12. French, GL, Shannon, KP, Simmons, N. Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and beta-lac-tam-beta-lactamase inhibitor combinations by hyperproduction of SHV-5 beta-lactamase. J Clin Microbiol 1996;34:358–363.CrossRefGoogle ScholarPubMed
13. O'Donnell, ED, Alter, KE, Frenkel, ID. Postoperative infection caused by an unusual serotype of Streptococcus pneumoniae associated with multiple drug resistance. J Clin Microbiol 1982;15:967–968.CrossRefGoogle ScholarPubMed
14. Kearns, B, Sabella, C, Mee, RB, Moodie, DS, Goldfarb, J. Sternal wound and mediastinal infections in infants with congenital heart disease. Cardiol Young 1999;9:280–284.CrossRefGoogle ScholarPubMed
15. Bhattacharyya, N, Kosloke, AM. Postoperative wound infection in pediatric surgical patients: a study of 676 infants and children. J Pediatr Surg 1990;25:125–129.CrossRefGoogle ScholarPubMed
16. Ruef, C, Fanconi, S, Nadal, D. Sternal wound infection after heart operations in pediatric patients associated with nasal carriage of Staphylococcus aureus . J Thorac Cardiovasc Surg 1996;112:681–686.CrossRefGoogle ScholarPubMed
17. Archibald, LK, Manning, ML, Bell, LM, Banerjee, S, Jarvis, WR. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 1997;16:10045–10048.CrossRefGoogle Scholar
18. Garner, JS, Jarvis, WR, Emori, TC, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
19. Centers for Disease Control. National nosocomial infection study. Quarterly Reports. Atlanta, GA: CDC; 1970-1983.Google Scholar
20. Meers, PD, Aycliffe, GAJ, Emmerson, AM, Leigh, DA, Mayon-White, RT, et al. Report on the national survey of infection in hospitals, 1980. J Hosp Infect 1981;2(suppl):1–51.CrossRefGoogle Scholar
21. Jepsen, OB, Mortensen, N. Prevalence of nosocomial infections and infection control in Denmark. J Hosp Infect 1980;1:237–244.CrossRefGoogle ScholarPubMed
22. Turner, JG, Pryor, ER. Review of infection control literature 1973 through 1981. Am J Infect Control 1986;14:234–238.CrossRefGoogle ScholarPubMed
23. Freishlag, J, Busuttil, RW. The value of postoperative fever evaluation. Surgery 1983;94:358–363.Google Scholar
24. Garibaldi, RA, Brodine, S, Matsumiya, S, Coleman, M. Evidence for the non-infectious etiology of early postoperative fever. Infect Control 1985;6:273–277.CrossRefGoogle ScholarPubMed
25. Verkkala, K, Valtonen, V, Jarvinen, A, Tolppanen, EM. Fever, leucocytosis and C-reactive protein after open heart surgery and their value in the diagnosis of postoperative infections. Thorac Cardiovasc Surg 1987;35:78–82.CrossRefGoogle ScholarPubMed
26. Miholic, J, Hiertz, H, Hudec, M, Laczkovics, A, Domanig, E. Fever, leucocytosis and infection after open heart surgery: a log-linear regression analysis of 115 cases. Thorac Cardiovasc Surg 1984;32:45–48.CrossRefGoogle ScholarPubMed
27. Moller, JH, Powell, CB, Joransen, JA, Borbas, C. The pediatric cardiac care consortium-revisited. Jt Comm J Qual Improv 1994;20:661–668.Google ScholarPubMed
28. Delius, RE, Kumar, RV, Elliott, MJ, Stark, J, de Leval, MR. Atrioventricular septal defect and tetralogy of Fallot: a 15-year experience. Eur J Cardiothorac Surg 1997;12:171–176.CrossRefGoogle Scholar