1022

Abstract

Introduction: Rampant misuse with irregular antibiotic regimen for management of preoperative sepsis in patients with congenital heart disease, is a harsh reality in developing nations. Inconsistent compliance with antimicrobial stewardship programs in emerging economies has resulted in a surge of XDR (carbapenem resistant) gram negative organisms with enhanced morbidity and mortality. Methods: This single centre retrospective observational study included patients operated for congenital heart disease in the duration, April 2012-March 2013. All the cases identified as positive for (XDR)gram negative blood stream infection(BSI), ventilator associated pneumonia (VAP ), surgical site infection (SSI), catheter associated urinary tract infection(CAUTI) and peritonitis were included . The analysis centred on the patient associated risk factors, microbiological profile, impact of preoperative hospitalisation with ventilation and final outcome. Results: Of the total 310 cultures positive in 452 cases operated over a year, 172 episodes of XDR sepsis requiring IV Colistin therapy were identified in 129 cases. The median Aristotle risk factor score in the study population (129 cases) was ≥8. The most commonly isolated organisms were Klebsiella Pneumoniae (39%) and Acinetobacter baumanii(29%).BSI (56%) and VAP(30%) were recorded and 12 % cases had evidence of multiple site involvement with recurrent cultures positive . Among 129 patients, 70 (54.3%) had evidence of preoperative sepsis and hospitalisation, and of these 21(30%) required preoperative ventilation. Preoperative MDR gram negative BSI was reported in 15 cases (21%) and 4 cases had fungal sepsis. 40 (57%) cases received preoperative Carbapenem therapy. IV Colistin, was used at a dosage of 7.5 to 10 mg per kg per day, for an average duration of 10 days for an individual cycle, and nephrotoxicity was reported in 4 (3.2%) patients . Of the 17 cases (13%) expired in this series, nine had infection related mortality. Conclusions: XDR gram negative sepsis, is a grim reality in developing nations and stringent antimicrobial stewardship programs at the primary and secondary health care levels, with timely referral mechanisms,deserve attention. Timely surgical intervention, in a ventilated patient, while it is recovering from preoperative sepsis, is the key to better outcome.