Epidemiology of nosocomial infections and mortality following congenital cardiac surgery in Cairo University, Egypt

Abstract

Nosocomial infections (NI) have been associated with significant morbidity and attributed mortality, as well as increased healthcare costs. Relatively few data on congenital cardiac surgical ICU NI have been reported from developing countries. Little is known about the epidemiology of NI following congenital cardiac surgery in Egypt. The aims of the present study were: (a) to estimate the incidence rate and types of NI among children admitted to Pediatric Surgical Cardiac ICU in Cairo University Children's Hospital (Egypt) and (b) to estimate the mortality rate related to congenital cardiac surgery and identify its contributing risk factors. A follow-up study in the period between 1 January 2009 and 1 January 2010 included all patients admitted to the Pediatric Surgical Cardiac ICU in Cairo University, Abo El Reesh Children's Specialized Hospital (Egypt). Data were collected for each patient during the preoperative, intraoperative, and postoperative periods. Certain infection control procedures were carried out in certain months. Of 175 patients, NI were identified in 119 (68%). Poor hand hygiene was associated with increased NI in certain months of the study duration. NI were significantly higher at a younger age [median 9 (5-30) months, P<0.03]. Mortality was found in 54 patients, that is, 31% of the study population. Mortality was significantly observed with younger age, higher complexity score for congenital cardiac lesions, prolonged cardiopulmonary bypass and ischemic times, NI, prolonged mechanical ventilation, prolonged central line insertion, and the use of total parenteral nutrition. Mortality among the NI patients was found in 44 of 119 (37%). On carrying out a multivariate analysis, Acute Physiology and Chronic Health Evaluation II score [P<0.001, odds ratio (OR) 1.13, 95% confidence interval (CI) 1-1.2], age (P<0.001, OR 0.3, 95% CI 0.2-0.4), and prolonged duration of mechanical ventilation (P<0.03, OR 2.8, 95% CI 1.1-7.2) were identified as risk factors of mortality. NI rate and subsequent mortality were high among cases followed up during the period from 1 January 2009 to 1 January 2010 in the University Children's Hospital (Cairo, Egypt). Early surgical interference, enforcement of proper infection control practices, especially hand hygiene, can reduce NI and trials for early extubation from mechanical ventilation might improve outcome following congenital cardiac surgery in pediatrics.