Comparative Study between Incidence and Risk Factors of Major and Minor Infections in Early Post-Operative Course of Pediatric Cardiac Surgery: A Single Center Study

Abstract

Abstract Background Nosocomial infections (NI) also termed as healthcare-associated infections (HCAIs) include infections that are acquired from a hospital or other health care centers, which appear for the first time within 48 hours of hospital admission, 3 days of discharge or 30 days of operation. However, in some cases, the NIs occur within 30 days after discharge, such as surgical site infections. Aim of the Work Primary aim: Identifying the frequency and risk factors of major and minor infection in the early postoperative course of pediatric cardiac surgery. Secondary Aim Identifying the most prevalent isolated microorganisms and the antimicrobial susceptibility pattern. Tertiary Aim Highlighting the points of improvement to reduce the incidence of post- operative infection in the center of study. Patients and Methods This study is a prospective cohort observational study conducted on patients who were admitted at post-operative Cardiac Pediatric Intensive Care Unit at Ain Shams University Hospitals over 6 months from May 2022 to November 2022. Results The study included 60 pediatric patients (32 males and 28 females) who underwent cardiac surgical intervention for congenital heart disease with ages ranging from 1 to 168 months and a median age of 30 months (IQR between 12 and 108 months). Out of 60 patients, 15% had postoperative major infections, 13.3% had minor infections and the rest (71.7%) developed neither major nor minor infection during the early post-operative period. The most common risk factors of infection (either major or minor) were the long duration on mechanical ventilation, central venous catheterization and postoperative need for blood transfusion (packed RBCs, plasma, PLT transfusion). Of the 350 collected culture samples;23 were positive (incidence 6.5%). The most common isolated gram positive organisms were staph aureus (incidence 1.1%), the most common isolated gram negative organisms were Klebsiella ssp (incidence 2.2%) followed by acintobater cepacia (incidence 1.4%) then E. coli (incidence 1.1%). No isolation of fungal infection was found. Regarding antimicrobial susceptibility pattern of these microorganisms, we found that they were sensitive to different spectrum of antibiotics. Factors assessing in decreasing the risk factors of major and minor infections during post-operative period included: early diagnosis of the type of organism responsible for nosocomial infection and early treatment with suitable antibiotics. Conclusion Major postoperative infections caused adverse outcomes in pediatric cardiac surgery and were associated with longer hospital stay. Blood components transfusions, duration of mechanical ventilation and central venous catheterization were associated with higher rates of nosocomial infections.