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Erschienen in: Pediatric Cardiology 1/2017

14.11.2016 | Original Article

Preoperative Staphylococcus aureus Carriage and Risk of Surgical Site Infection After Cardiac Surgery in Children Younger than 1 year: A Pilot Cohort Study

verfasst von: J. Macher, C. Gras Le Guen, A. Chenouard, J. M. Liet, B. Gaillard Le Roux, A. Legrand, J. Mahuet, E. Launay, V. Gournay, N. Joram

Erschienen in: Pediatric Cardiology | Ausgabe 1/2017

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Abstract

Surgical site infections (SSI) increase length of stay, morbidity, mortality and cost of hospitalization. Staphylococcus aureus (SA) carriage is a known risk factor of SSI in adults, but its role in pediatrics remains uncertain. The main objective of this pilot prospective monocentric cohort study was to describe the prevalence of SA colonization in children under 1 year old before cardiac surgery. The secondary objectives were to compare the incidence of SSI and other nosocomial infections (NI) between preoperative carriers and non-carriers. From May 2012 to November 2013, all children <1 year old undergoing cardiac surgery under cardiopulmonary bypass underwent preoperative methicillin-resistant (MRSA) and methicillin-sensitive SA (MSSA) screening using real-time PCR. The only exclusion criterion was invalid PCR. All patients were followed up to 1 year after the surgery regarding SSI and other nosocomial infections. Among the 68 studied patients, SA colonization prevalence was 26.5%, comprising 23.5% MSSA and 2.9% MRSA. There was no significant difference between colonized and non-colonized children regarding SSI rate (16.7 vs 20%; p = 0.53), but ventilator-associated pneumonia rate was significantly higher among the SA carriers (22.2 vs 2%; p < 0.05). The colonization rate was different depending on the age of the patients (p < 0.05). This pilot study highlights that colonization with MSSA is frequent whereas MRSA prevalence is low in our population. In this cohort, there was no association between SA colonization and SSI incidence but further studies are needed to analyze this association.
Literatur
3.
Zurück zum Zitat Mehta PA, Cunningham CK, Colella CB, Alferis G, Weiner LB (2000) Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. Pediatr Infect Dis J 19(10):1000–1004CrossRefPubMed Mehta PA, Cunningham CK, Colella CB, Alferis G, Weiner LB (2000) Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. Pediatr Infect Dis J 19(10):1000–1004CrossRefPubMed
4.
Zurück zum Zitat Long CB, Shah SS, Lautenbach E, Coffin SE, Tabbutt S, Gaynor JW, Bell LM (2005) Postoperative mediastinitis in children: epidemiology, microbiology and risk factors for Gram-negative pathogens. Pediatr Infect Dis J 24(4):315–319CrossRefPubMed Long CB, Shah SS, Lautenbach E, Coffin SE, Tabbutt S, Gaynor JW, Bell LM (2005) Postoperative mediastinitis in children: epidemiology, microbiology and risk factors for Gram-negative pathogens. Pediatr Infect Dis J 24(4):315–319CrossRefPubMed
7.
Zurück zum Zitat Levy I, Ovadia B, Erez E, Rinat S, Ashkenazi S, Birk E, Konisberger H, Vidne B, Dagan O (2003) Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors. J Hosp Infect 53(2):111–116CrossRefPubMed Levy I, Ovadia B, Erez E, Rinat S, Ashkenazi S, Birk E, Konisberger H, Vidne B, Dagan O (2003) Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors. J Hosp Infect 53(2):111–116CrossRefPubMed
8.
Zurück zum Zitat Muñoz P, Hortal J, Giannella M, Barrio JM, Rodríguez-Créixems M, Pérez MJ, Rincón C, Bouza E (2008) Nasal carriage of S. aureus increases the risk of surgical site infection after major heart surgery. J Hosp Infect 68(1):25–31CrossRefPubMed Muñoz P, Hortal J, Giannella M, Barrio JM, Rodríguez-Créixems M, Pérez MJ, Rincón C, Bouza E (2008) Nasal carriage of S. aureus increases the risk of surgical site infection after major heart surgery. J Hosp Infect 68(1):25–31CrossRefPubMed
9.
Zurück zum Zitat Kluytmans J, van Belkum A, Verbrugh H (1997) Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 10:505–520PubMedPubMedCentral Kluytmans J, van Belkum A, Verbrugh H (1997) Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 10:505–520PubMedPubMedCentral
12.
Zurück zum Zitat Milstone AM, Goldner BW, Ross T, Shepard J, Carroll KC, Perl TM (2011) Methicillin-resistant Staphylococcus aureus colonization and risk of subsequent infection in critically ill children: importance of preventing nosocomial methicillin-resistant Staphylococcus aureus transmission. Clin Infect Dis 53(9):853–859. doi:10.1093/cid/cir547 CrossRefPubMedPubMedCentral Milstone AM, Goldner BW, Ross T, Shepard J, Carroll KC, Perl TM (2011) Methicillin-resistant Staphylococcus aureus colonization and risk of subsequent infection in critically ill children: importance of preventing nosocomial methicillin-resistant Staphylococcus aureus transmission. Clin Infect Dis 53(9):853–859. doi:10.​1093/​cid/​cir547 CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Peacock SJ, Justice A, Griffiths D, de Silva GD, Kantzanou MN, Crook D, Sleeman K, Day NP (2003) Determinants of acquisition and carriage of Staphylococcus aureus in infancy. J Clin Microbiol 41(12):5718–5725CrossRefPubMedPubMedCentral Peacock SJ, Justice A, Griffiths D, de Silva GD, Kantzanou MN, Crook D, Sleeman K, Day NP (2003) Determinants of acquisition and carriage of Staphylococcus aureus in infancy. J Clin Microbiol 41(12):5718–5725CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Lacour-Gayet F, Clarke D, Jacobs J, Comas J, Daebritz S, Daenen W, Gaynor W, Hamilton L, Jacobs M, Maruszsewski B, Pozzi M, Spray T, Stellin G, Tchervenkov C, Mavroudis C, the Aristotle Committee (2004) The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 25:911–924. doi:10.1016/j.ejcts.2004.03.027 CrossRefPubMed Lacour-Gayet F, Clarke D, Jacobs J, Comas J, Daebritz S, Daenen W, Gaynor W, Hamilton L, Jacobs M, Maruszsewski B, Pozzi M, Spray T, Stellin G, Tchervenkov C, Mavroudis C, the Aristotle Committee (2004) The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 25:911–924. doi:10.​1016/​j.​ejcts.​2004.​03.​027 CrossRefPubMed
15.
16.
Zurück zum Zitat Gesualdo F, Onori M, Bongiorno D, Campanile F, Carloni E, Mancinelli L, Russo C, Villani A, Valentini D, Raponi M, Tozzi AE, Stefani S (2014) Methicillin-resistant Staphylococcus aureus nasal colonization in a department of pediatrics: a cross-sectional study. Ital J Pediatr. doi:10.1186/1824-7288-40-3 PubMedPubMedCentral Gesualdo F, Onori M, Bongiorno D, Campanile F, Carloni E, Mancinelli L, Russo C, Villani A, Valentini D, Raponi M, Tozzi AE, Stefani S (2014) Methicillin-resistant Staphylococcus aureus nasal colonization in a department of pediatrics: a cross-sectional study. Ital J Pediatr. doi:10.​1186/​1824-7288-40-3 PubMedPubMedCentral
17.
Zurück zum Zitat Gesualdo F, Bongiorno D, Rizzo C, Bella A, Menichella D, Stefani S, Tozzi AE (2013) MRSA nasal colonization in children: prevalence meta-analysis, review of risk factors and molecular genetics. Pediatr Infect Dis J 32(5):479–485. doi:10.1097/INF.0b013e3182864e4c CrossRefPubMed Gesualdo F, Bongiorno D, Rizzo C, Bella A, Menichella D, Stefani S, Tozzi AE (2013) MRSA nasal colonization in children: prevalence meta-analysis, review of risk factors and molecular genetics. Pediatr Infect Dis J 32(5):479–485. doi:10.​1097/​INF.​0b013e3182864e4c​ CrossRefPubMed
18.
Zurück zum Zitat Bode LG, Kluytmans JA, Wertheim HF, Bogaers D, Vandenbroucke-Grauls CM, Roosendaal R, Troelstra A, Box AT, Voss A, van der Tweel I, van Belkum A, Verbrugh HA, Vos MC (2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 362(1):9–17. doi:10.1056/NEJMoa0808939 CrossRefPubMed Bode LG, Kluytmans JA, Wertheim HF, Bogaers D, Vandenbroucke-Grauls CM, Roosendaal R, Troelstra A, Box AT, Voss A, van der Tweel I, van Belkum A, Verbrugh HA, Vos MC (2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 362(1):9–17. doi:10.​1056/​NEJMoa0808939 CrossRefPubMed
19.
Zurück zum Zitat Jog S, Cunningham R, Cooper S, Wallis M, Marchbank A, Vasco-Knight P, Jenks PJ (2008) Impact of preoperative screening for meticillin-resistant Staphylococcus aureus by real-time polymerase chain reaction in patients undergoing cardiac surgery. J Hosp Infect 69(2):124–130. doi:10.1016/j.jhin.2008.02.008 CrossRefPubMed Jog S, Cunningham R, Cooper S, Wallis M, Marchbank A, Vasco-Knight P, Jenks PJ (2008) Impact of preoperative screening for meticillin-resistant Staphylococcus aureus by real-time polymerase chain reaction in patients undergoing cardiac surgery. J Hosp Infect 69(2):124–130. doi:10.​1016/​j.​jhin.​2008.​02.​008 CrossRefPubMed
21.
Zurück zum Zitat Société française d’hygiène hospitalière. (2013) Recommandations. Gestion pré-opératoire du risque infectieux. Mise à jour de la conférence de consensus. Hygiènes Volume XXI no 4 Société française d’hygiène hospitalière. (2013) Recommandations. Gestion pré-opératoire du risque infectieux. Mise à jour de la conférence de consensus. Hygiènes Volume XXI no 4
24.
Zurück zum Zitat Barraud D, Blard C, Hein F, Marçon O, Cravoisy A, Nace L, Alla F, Bollaert PE, Gibot S (2015) Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial. Intensive Care Med 36(9):1540–1547. doi:10.1007/s00134-010-1927-0 CrossRef Barraud D, Blard C, Hein F, Marçon O, Cravoisy A, Nace L, Alla F, Bollaert PE, Gibot S (2015) Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial. Intensive Care Med 36(9):1540–1547. doi:10.​1007/​s00134-010-1927-0 CrossRef
25.
26.
Zurück zum Zitat Banupriya B, Biswal N, Srinivasaraghavan R, Narayanan P, Mandal J (2015) Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive Care Med 41(4):677–685. doi:10.1007/s00134-015-3694-4 CrossRefPubMed Banupriya B, Biswal N, Srinivasaraghavan R, Narayanan P, Mandal J (2015) Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive Care Med 41(4):677–685. doi:10.​1007/​s00134-015-3694-4 CrossRefPubMed
27.
Zurück zum Zitat Faa G, Gerosa C, Fanni D, Nemolato S, van Eyken P, Fanos V (2013) Factors influencing the development of a personal tailored microbiota in the neonate, with particular emphasis on antibiotic therapy. J Matern Fetal Neonatal Med 26(Suppl 2):35–43. doi:10.3109/14767058.2013.829700 CrossRefPubMed Faa G, Gerosa C, Fanni D, Nemolato S, van Eyken P, Fanos V (2013) Factors influencing the development of a personal tailored microbiota in the neonate, with particular emphasis on antibiotic therapy. J Matern Fetal Neonatal Med 26(Suppl 2):35–43. doi:10.​3109/​14767058.​2013.​829700 CrossRefPubMed
28.
Zurück zum Zitat Allpress AL, Rosenthal GL, Goodrich KM, Lupinetti FM, Zerr DM (2004) Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J. 23(3):231–234CrossRefPubMed Allpress AL, Rosenthal GL, Goodrich KM, Lupinetti FM, Zerr DM (2004) Risk factors for surgical site infections after pediatric cardiovascular surgery. Pediatr Infect Dis J. 23(3):231–234CrossRefPubMed
29.
Zurück zum Zitat Wolk DM, Picton E, Johnson D, Davis T, Pancholi P, Ginocchio CC, Finegold S, Welch DF, de Boer M, Fuller D, Solomon MC, Rogers B, Mehta MS, Peterson LR (2009) Multicenter evaluation of the Cepheid Xpert methicillin-resistant Staphylococcus aureus (MRSA) test as a rapid screening method for detection of MRSA in nares. J Clin Microbiol 47(3):758–764. doi:10.1128/JCM.01714-08 CrossRefPubMedPubMedCentral Wolk DM, Picton E, Johnson D, Davis T, Pancholi P, Ginocchio CC, Finegold S, Welch DF, de Boer M, Fuller D, Solomon MC, Rogers B, Mehta MS, Peterson LR (2009) Multicenter evaluation of the Cepheid Xpert methicillin-resistant Staphylococcus aureus (MRSA) test as a rapid screening method for detection of MRSA in nares. J Clin Microbiol 47(3):758–764. doi:10.​1128/​JCM.​01714-08 CrossRefPubMedPubMedCentral
31.
Metadaten
Titel
Preoperative Staphylococcus aureus Carriage and Risk of Surgical Site Infection After Cardiac Surgery in Children Younger than 1 year: A Pilot Cohort Study
verfasst von
J. Macher
C. Gras Le Guen
A. Chenouard
J. M. Liet
B. Gaillard Le Roux
A. Legrand
J. Mahuet
E. Launay
V. Gournay
N. Joram
Publikationsdatum
14.11.2016
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 1/2017
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-016-1499-z

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