Skip to main content

Advertisement

Springer Nature Link
Log in

Nosocomial infections in infants and children after cardiac surgery

  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

To identify the incidence, characteristics and risk factors of nosocomial infections (NIs) in infants and children undergoing open heart surgery, a prospective observational study.

Methods

One hundred consecutive infants and children < 2 yrs of age undergoing open heart surgery (OHS) between March 2007 and December 2007 were included in the study. Samples for blood, endotracheal and urine culture were drawn daily during intensive care unit (ICU) stay. Cultures from endotracheal tube, central venous catheter, arterial cannula, chest tube, urinary catheter and other invasive lines were also obtained. Centers for Disease Control and Prevention criteria were used for defining NIs. A number of possible risk factors predisposing to NI were analyzed.

Results

32% patients developed NI. The NI rate was 49%. Common NIs were bloodstream infection (19%), respiratory tract infection (17%), catheter site infection (7%) and urinary tract infection (6%). Common pathogens were Acinetobacter (22.5%), Pseudomonas aeruginosa (20.4%), Klebsiella pneumoniae (16.3%) and Staphylococcus aureus (12.2%). Major risk factors for NI were length of ICU stay (p < 0.001), duration of intubation (p < 0.001), reintubation (p < 0.001), duration of central venous catheterization (p = 0.001), preoperative congestive heart failure (p = 0.002), tracheostomy (p = 0.003), duration of preoperative stay (p = 0.01), blood transfusion (p = 0.01), preoperative balloon atrial septostomy (p = 0.02), duration of surgery (p = 0.03), surgical complexity score (p = 0.03) and hypothermia (p = 0.03). The mortality rate was 11% with significant association between NI and death (p = 0.002).

Conclusion

NIs develop frequently in infants and children after OHS. This study may serve as a reference point for further development and implementation of interventions aimed at reducing NI rates and improving patient outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  1. Bailey & Scott. Diagnostic Microbiology. Ninth Edition. Mosby Year Book, Inc, 1994.

  2. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Fifteenth Informational Supplement M100-S15. CLSI, Wayne, PA, USA, 2006.

    Google Scholar 

  3. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.

    Article  PubMed  CAS  Google Scholar 

  4. Alphonso N, Anagnostopoulos PV, Scarpace S, et al. Perioperative antibiotic prophylaxis in paediatric cardiac surgery. Cardiol Young 2007;17:12–25.

    Article  PubMed  Google Scholar 

  5. Valera M, Scolfaro C, Cappello N, et al. Nosocomial infections in pediatric cardiac surgery, Italy. Infect Control Hosp Epidemiol 2001;22:771–775.

    Article  PubMed  CAS  Google Scholar 

  6. Dagan O, Cox PN, Ford-Jones L, Ponsonby J, Bohn DJ. Nosocomial infection following cardiovascular surgery: comparison of two periods, 1987 vs. 1992. Crit Care Med 1999;27:104–108.

    Article  PubMed  CAS  Google Scholar 

  7. Pollock EM, Ford-Jones EL, Rebeyka I, et al. Early nosocomial infections in pediatric cardiovascular surgery patients. Crit Care Med 1990;18:378–384.

    Article  PubMed  CAS  Google Scholar 

  8. Mantero E, Panizzon G, Tacchella A, et al. Occurrence of hospital infections in a department of pediatric heart surgery. Pediatr Med Chir 1986;8:715–720.

    PubMed  CAS  Google Scholar 

  9. Levy I, Ovadia B, Erez E, et al. Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors. J Hosp Infect 2003;53:111–116.

    Article  PubMed  CAS  Google Scholar 

  10. Tan L, Sun X, Zhu X, Zhang Z, Li J, Shu Q. Epidemiology of nosocomial pneumonia in infants after cardiac surgery. Chest 2004;125:410–417.

    Article  PubMed  Google Scholar 

  11. Ryan T, Mc Carthy JF, Rady MY, et al. Early bloodstream infection after cardiopulmonary bypass: frequency rate, risk factors, and implications. Crit Care Med 1997;25:2009–2014.

    Article  PubMed  CAS  Google Scholar 

  12. Leal-Noval SR, Rincón-Ferrari MD, García-Curiel A, et al. Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery. Chest 2001;119:1461–1468.

    Article  PubMed  CAS  Google Scholar 

  13. Trouillet JL, Chastre J, Vuagnat A, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998;157:531–539.

    PubMed  CAS  Google Scholar 

  14. Rosenthal VD, Maki DG, Salomao R, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries: Ann Intern Med 2006;145:582–591.

    PubMed  Google Scholar 

  15. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000;118:146–155.

    Article  PubMed  CAS  Google Scholar 

  16. Jenkins KJ, Newburger JW, Lock JE, Davis RB, Coffman GA, Iezzoni LI. In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 1995;95:323–330.

    PubMed  CAS  Google Scholar 

  17. Hannan EL, Racz M, Kavey RE, Quaegebeur JM, Williams R. Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics 1998;101:963–969.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Suruchi Hasija, Neeti Makhija & Usha Kiran

  2. Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Shiv Kumar Choudhary & Sachin Talwar

  3. Department of Microbiology, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Arti Kapil

  4. Department of Cardiac Anaesthesia 7th Floor, Cardiothoracic Centre All India Institute of Medical Sciences Ansari Nagar, New Delhi, 110029, India

    Neeti Makhija

Authors
  1. Suruchi Hasija
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Neeti Makhija
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Usha Kiran
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Shiv Kumar Choudhary
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Sachin Talwar
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Arti Kapil
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Neeti Makhija.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hasija, S., Makhija, N., Kiran, U. et al. Nosocomial infections in infants and children after cardiac surgery. Indian J Thorac Cardiovasc Surg 24, 233–239 (2008). https://doi.org/10.1007/s12055-008-0052-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-008-0052-y

Key words