2
|
Yu X, Chen M, Liu X, Chen Y, Hao Z, Zhang H, Wang W. Risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease. BMC Infect Dis 2020; 20:64. [PMID: 31964345 PMCID: PMC6975050 DOI: 10.1186/s12879-020-4769-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/07/2020] [Indexed: 01/22/2023] Open
Abstract
Background The aim of our study was to analyze the risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease (CHD). Methods We performed a retrospective cohort study, and children with CHD who underwent open-heart surgeries at Shanghai Children’s Medical Center from January 1, 2012 to December 31, 2018 were included. The baseline characteristics of these patients of different ages, including neonates (0–1 months old), infants (1–12 months old) and children (1–10 years old), were analyzed, and the association of risk factors with postoperative nosocomial infection were assessed. Results A total of 11,651 subjects were included in the study. The overall nosocomial infection rate was 10.8%. Nosocomial infection rates in neonates, infants, and children with congenital heart disease were 32.9, 15.4, and 5.2%, respectively. Multivariate logistic regression analysis found age (OR 0798, 95%CI: 0.769–0.829; P < 0.001), STS risk grade (OR 1.267, 95%CI: 1.159–1.385; P < 0.001), body mass index (BMI) <5th percentile (OR 1.295, 95%CI: 1.023–1.639; P = 0.032), BMI >95th percentile (OR 0.792, 95%CI: 0.647–0.969; P = 0.023), cardiopulmonary bypass (CPB) time (OR 1.008, 95%CI: 1.003–1.012; P < 0.001) and aortic clamping time (OR 1.009, 1.002–1.015; P = 0.008) were significantly associated with nosocomial infection in CHD infants. After adjusted for confounding factors, we found STS risk grade (OR 1.38, 95%CI: 1.167–1.633; P < 0.001), BMI < 5th percentile (OR 1.934, 95%CI: 1.377–2.715; P < 0.001), CPB time (OR 1.018, 95%CI: 1.015–1.022; P < 0.001), lymphocyte/WBC ratio<cut off value (OR 3.818, 95%CI: 1.529–9.533; P = 0.004) and AST>cut off value (OR 1.546, 95%CI: 1.119–2.136; P = 0.008) were significantly associated with nosocomial infection in CHD children. Conclusion Our study suggested STS risk grade, BMI, CPB duration, low lymphocyte/WBC or high neutrophil/WBC ratio were independently associated with nosocomial infection in CHD infant and children after cardiac surgery.
Collapse
Affiliation(s)
- Xindi Yu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Maolin Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Xu Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Yiwei Chen
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Zedong Hao
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China.
| | - Wei Wang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China.
| |
Collapse
|
3
|
Sen AC, Morrow DF, Balachandran R, Du X, Gauvreau K, Jagannath BR, Kumar RK, Kupiec JK, Melgar ML, Chau NT, Potter-Bynoe G, Tamariz-Cruz O, Jenkins KJ. Postoperative Infection in Developing World Congenital Heart Surgery Programs: Data From the International Quality Improvement Collaborative. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.002935. [PMID: 28408715 DOI: 10.1161/circoutcomes.116.002935] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 03/03/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative infections contribute substantially to morbidity and mortality after congenital heart disease surgery and are often preventable. We sought to identify risk factors for postoperative infection and the impact on outcomes after congenital heart surgery, using data from the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries. METHODS AND RESULTS Pediatric cardiac surgical cases performed between 2010 and 2012 at 27 participating sites in 16 developing countries were included. Key variables were audited during site visits. Demographics, preoperative, procedural, surgical complexity, and outcome data were analyzed. Univariate and multivariable logistic regression were used to identify risk factors for infection, including bacterial sepsis and surgical site infection, and other clinical outcomes. Standardized infection ratios were computed to track progress over time. Of 14 545 cases, 793 (5.5%) had bacterial sepsis and 306 (2.1%) had surgical site infection. In-hospital mortality was significantly higher among cases with infection than among those without infection (16.7% versus 5.3%; P<0.001), as were postoperative ventilation duration (80 versus 14 hours; P<0.001) and intensive care unit stay (216 versus 68 hours; P<0.001). Younger age at surgery, higher surgical complexity, lower oxygen saturation, and major medical illness were independent risk factors for infection. The overall standardized infection ratio was 0.65 (95% confidence interval, 0.58-0.73) in 2011 and 0.59 (95% confidence interval, 0.54-0.64) in 2012, compared with that in 2010. CONCLUSIONS Postoperative infections contribute to mortality and morbidity after congenital heart surgery. Younger, more complex patients are at particular risk. Quality improvement targeted at infection risk may reduce morbidity and mortality in the developing world.
Collapse
Affiliation(s)
- Amitabh Chanchal Sen
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.).
| | - Debra Forbes Morrow
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Rakhi Balachandran
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Xinwei Du
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Kimberlee Gauvreau
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Byalal R Jagannath
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Raman Krishna Kumar
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Jennifer Koch Kupiec
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Monica L Melgar
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Nguyen Tran Chau
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Gail Potter-Bynoe
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Orlando Tamariz-Cruz
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| | - Kathy J Jenkins
- From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.)
| |
Collapse
|
5
|
Takanashi M, Ogata S, Honda T, Nomoto K, Mineo E, Kitagawa A, Ando H, Kimura S, Nakahata Y, Oka N, Miyaji K, Ishii M. Timing of Haemophilus influenzae type b vaccination after cardiac surgery. Pediatr Int 2016; 58:691-7. [PMID: 26718621 DOI: 10.1111/ped.12899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/29/2015] [Accepted: 12/24/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The best time for vaccination in infants with congenital heart disease (CHD) after cardiopulmonary bypass (CPB) surgery is unclear, but it is important to prevent Haemophilus influenzae type b (Hib) infection in infants with CHD after CPB surgery. To identify the best time for Hib vaccination in infants with CHD after CPB surgery, we investigated the immunological status, and the efficacy and safety of Hib vaccination after CPB surgery. METHODS Sixteen subjects who underwent surgical correction of ventricular septal defect with CPB were investigated. Immunological status and cytokines were analyzed before surgery, 2 months after surgery, and before Hib booster vaccination. Hib-specific IgG was also measured to evaluate the effectiveness of vaccination. RESULTS Immunological status before and 2 months after surgery (e.g. whole blood cells and lymphocyte subset profile) was within the normal range and no subjects had hypercytokinemia. Additionally, all subjects who received Hib vaccination at 2-3 months after CPB surgery had effective serum Hib-specific IgG level for protection against Hib infection without any side-effects. CONCLUSIONS CPB surgery does not influence acquired immunity and Hib vaccination may be immunologically safe to perform at 2 months after CPB surgery. Hib vaccination at 2-3 months after CPB surgery was effective in achieving immunization for infants with simple left-right shunt-type CHD.
Collapse
Affiliation(s)
- Manabu Takanashi
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shohei Ogata
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takashi Honda
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Keiko Nomoto
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Eri Mineo
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Atsushi Kitagawa
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hisashi Ando
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Sumito Kimura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yayoi Nakahata
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Norihiko Oka
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masahiro Ishii
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| |
Collapse
|