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Wang X, Li S, Huo D, Zhu Z, Wang W, He H, Zhang Q, Li J, Wang X. Nosocomial Infections After Pediatric Congenital Heart Disease Surgery: Data from National Center for Cardiovascular Diseases in China. Infect Drug Resist 2024; 17:1615-1623. [PMID: 38694890 PMCID: PMC11061562 DOI: 10.2147/idr.s457991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/23/2024] [Indexed: 05/04/2024] Open
Abstract
Purpose Infection prevention and control (IPC) has a significant impact on the prognosis after pediatric cardiac surgery. This study aimed to provide surveillance data on the incidence and density of various infections during the COVID-19 epidemic and explore the influence of multi-drug resistant organisms (MDRO) on in-hospital prognosis after congenital heart disease surgery. Methods This single-center retrospective study included pediatric patients who underwent cardiac surgery between 2021 and 2022. The results of the postoperative bacterial and fungal cultures and antimicrobial stewardship were collected. The demographic characteristics (age and weight), operation-related parameters (RACHS-1 grade, duration of cardiopulmonary bypass, and aortic cross clamp), and surgical outcomes (extracorporeal membrane oxygenation, delayed sternal closure, mortality, duration of mechanical ventilation, length of intensive care unit stay and hospital stay, and hospitalization costs) of MDRO and non-MDRO patients were compared. Results A total of 4776 patients were included. There were 101 infectious culture results after the operation, with a nosocomial infection rate of 2.1%. There were 40 MDRO specimens from 36 patients, 50 non-MDRO specimens from 30 patients, and 11 fungal specimens from 10 patients. The incidence of pneumonia was 1.5%, with a ventilator-associated pneumonia incidence density of 7.2/1000 patient-days. The incidence of sepsis was 0.4%, with a catheter-related bloodstream infection incidence density of 0.24/ 1000 patient-days. The incidence density of catheter-associated tract infection was 0.45/ 1000 patient-days. The incidence of surgical site infection was 0.06%. The culture proportion before commencing antibiotics was 93% and the antibiotic consumption intensity was 30.7 DDD/100 bed-days. The length of intensive care unit stay in MDRO infection patients increased compared with that in non-MDRO infection patients, 30 (18,52) vs 17 (7,62) days, p=0.05). Conclusion The IPC performance of Fuwai Hospital achieved satisfactory results. MDRO infection can lead to prolonged intensive care unit stay.
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Affiliation(s)
- Xiaofeng Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Shuo Li
- Department of Infection Control, Peking University First Hospital, Beijing, People’s Republic of China
| | - Da Huo
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, People’s Republic of China
| | - Zhiyuan Zhu
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Wenlong Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Hongxia He
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qian Zhang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jiantao Li
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Department of Infection Control, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
| | - Xu Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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Wang X, Li S, Huo D, Wang S, Wang W, He H, Zhang Q, Li J, Wang X. Healthcare associated infection management in 62 intensive care units for patients with congenital heart disease in China, a survey study. Int J Surg 2024; 110:01279778-990000000-01027. [PMID: 38320095 PMCID: PMC11020057 DOI: 10.1097/js9.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES All patients with congenital heart disease (CHD) receive postoperative management in ICUs. Infection prevention and control (IPC) has a significant impact on prognosis. This study provides a preliminary understanding of the fundamental aspects of IPC in ICUs following CHD surgery in China. METHODS From September to October 2023, we initiated a survey on HAI management in hospitals that perform CHD surgeries independently. The questionnaires were jointly completed by the ICU physicians and IPC personnel. Duplicate or unqualified questionnaires were excluded from the study. The contents of our questionnaires covered hospital and ICU capacity, performance of the infection control department, HAI surveillance, implementation of IPC measures, and antimicrobial stewardship (AMS). Qualified questionnaires were compared according to the volume of annual CHD surgeries performed in different ICUs. Group 1 was defined as volume > 300 cases and group 2 was defined as volume ≤300 cases. RESULTS 62 of the 118 questionnaires were completed, with a response rate of 53%. The CHD surgical volume in 2022 of the 62 hospitals was 36342, accounting for 52% of the annual CHD surgical volume (69672) across the country. The postoperative infection rates obtained from the 15 ICUs varied from 1.3% to 15%, with a median rate of 4.5%. A total of 16 ICUs provided data on drug-resistant bacteria, Klebsiella pneumoniae exhibiting the highest frequency. More than 95% of ICUs have established complete HAI management systems. Information-based HAI surveillance was conducted in 89% of ICUs. Approximately 67% of ICUs stopped prophylactic antibiotics within 48 hours after surgery. In complex cases, carbapenems were administered empirically in 89% of ICUs. Group 1 had an advantage over group 2 in preventing multidrug-resistant organisms (all instruments should be used alone 100% vs. 86%, P=0.047; cleaning and disinfection of environmental surfaces, 100% vs. 81%, P=0.035; antibiotic consumption control 85% vs. 61%, P=0.044) and in preventing surgical site infections (perioperative blood glucose monitoring, 88% vs. 67%, P=0.048). However, Group 1 did not perform well in preventing catheter-related bloodstream infection (delayed catheter removal due to convenience of laboratory tests, 31% vs. 6%, P=0.021) and catheter-associated urinary tract infection (delayed catheter removal due to muscle relaxant administration, 88% vs. 58%, P=0.022). CONCLUSIONS A relatively complete HAI management system has been established throughout the country in ICUs for CHD patients. Information-based surveillance of HAI needs to be promoted, and actions should be taken to facilitate the implementation of IPC measures and AMS bundles. Training and feedback are critical for implementing IPC measures.
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Affiliation(s)
- Xiaofeng Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Shuo Li
- Department of Infection Control, Peking University First Hospital
| | - Da Huo
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Shilin Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Wenlong Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Hongxia He
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Qian Zhang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Jiantao Li
- Department of Infection Control, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Xu Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
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Kahan Y, Tope SG, Ovadia A, Shpring A, Shatzman-Steuerman R, Sherman G, Barkai G, Mandelberg A, Armoni-Domany K, Tasher D. Risk Factors and Characteristics of Candidemia After Cardiac Surgery in Pediatric Patients in Central Israel. Pediatr Infect Dis J 2023; 42:368-373. [PMID: 36854105 DOI: 10.1097/inf.0000000000003847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Candidemia is a serious complication in pediatric patients with congenital heart defects (CHD) after cardiac surgery. Information about the epidemiology, clinical characteristics and risk factors for candidemia in this vulnerable population remains limited. METHODS This retrospective case-control study was conducted in 2 pediatric intensive care units between 2004 and 2019. All patients <18 years old who developed candidemia following cardiac surgery were included. Each case was matched with 2 control patients based on age and date of surgery. Multivariable logistic regression analysis was conducted to determine the risk factors for postoperative candidemia. RESULTS Thirty-five candidemia cases were identified and matched to 70 control cases. The incidence of candidemia was 6.3 episodes per 1000 admissions. The median age for candidemia cases was 4 months. The attributable mortality was 28.5%. The predominant (54%) pathogens isolated were non- albicans Candida species, of which C. parapsilosis isolates demonstrated high resistance to fluconazole (70%). Independent risk factors associated with candidemia included cumulative antibiotic exposure for ≥4 days [OR: -4.3; 95% confidence interval (CI): 1.3-14.6; P = 0.02], the need for total parenteral nutrition or peritoneal dialysis (OR: -6.1; 95% CI: 2-18.8; P = 0.001), male sex (OR: 6.2; 95% CI: 1.9-20.3; P = 0.002) and delayed sternal closure≥2 days (OR: -3.2; 95% CI: 1-11.2; P = 0.05). CONCLUSIONS Postoperative candidemia in children with CHD is an uncommon but severe complication. Our study revealed an unexpectedly high frequency of fluconazole-resistant C. parapsilosis as the main cause of non- albicans candidemia. In addition to confirming previously recognized risk factors, our results reveal new potential risk factors such as delayed sternal closure and male sex.
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Affiliation(s)
- Yaara Kahan
- Pediatric Infectious Diseases Unit, Edith Wolfson Medical Center, Holon, Israel
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Samantha G Tope
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Adi Ovadia
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Adi Shpring
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Rachel Shatzman-Steuerman
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gilad Sherman
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Galia Barkai
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avigdor Mandelberg
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Keren Armoni-Domany
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Diana Tasher
- Pediatric Infectious Diseases Unit, Edith Wolfson Medical Center, Holon, Israel
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
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Jayawardena-Thabrew H, Warris A, Ferreras-Antolin L, Demirjian A, Drysdale SB, Emonts M, McMaster P, Paulus S, Patel S, Kinsey S, Vergnano S, Whittaker E, Ferreras-Antolin L. Nystatin is commonly prescribed as prophylaxis in children beyond the neonatal age. Med Mycol 2022; 61:6969424. [PMID: 36610724 DOI: 10.1093/mmy/myac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
The indications for nystatin as prophylaxis or treatment are limited. In the PASOAP (Pediatric Antifungal Stewardship Optimizing Antifungal Prescription) study, high use of nystatin in hospitalized children beyond the neonatal age was observed. In this report, we present the data on nystatin use in infants and children ≥ 3 months who participated in the PASOAP study. Nystatin was prescribed mainly for prophylaxis. Congenital heart disease, cystic fibrosis, and chronic renal disease were the most commonly reported conditions in children receiving prophylactic nystatin. There is sparse evidence supporting the use of nystatin prophylaxis beyond neonates; trials in specific pediatric patient groups are required.
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Affiliation(s)
| | - Adilia Warris
- Medical Research Council Center for Medical Mycology, University of Exeter, Exeter, United Kingdom.,Department of Pediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Laura Ferreras-Antolin
- Medical Research Council Center for Medical Mycology, University of Exeter, Exeter, United Kingdom.,Pediatric Infectious Diseases and Immunology Unit, St George's University Hospitals, NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | - Laura Ferreras-Antolin
- Medical Research Council Centre for Medical Mycology. University of Exeter , UK
- Paediatric Infectious Diseases and Immunology Unit. St George's University Hospitals NHS Foundation Trust , London , UK
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Effect of the Kanghuier Transparent Hydrocolloid Dressing in Preventing Central Venous Catheter Infection and Phlebitis after Cardiac Surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4700257. [PMID: 35401782 PMCID: PMC8993560 DOI: 10.1155/2022/4700257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 12/02/2022]
Abstract
Background As cardiac surgery is complicated, time-consuming, and traumatic, it may cause great damage to the patient's body. Therefore, postoperative indwelling venous catheters are required for hemodynamic monitoring and rapid fluid replenishment. Intravenous catheterization infection can easily lead to phlebitis, which not only affects the success of the operation and patient recovery but may also lead to death in severe cases. Good perioperative care is key to reducing postoperative infection in patients, and the choice of dressings for patients with catheterization plays an important role in reducing catheter infection. Objective The Kanghuier transparent hydrocolloid dressing is known to effectively prevent and treat wound infections. This study is aimed at exploring whether it can reduce the incidence of postoperative catheter infection and phlebitis in patients undergoing cardiac surgery. Methods A total of 196 patients undergoing cardiac surgery in the Department of Cardiothoracic Surgery of Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University) from January 2020 to June 2020 were selected. Among them, 98 patients receiving Kanghuier transparent dressing intervention were selected as group A, and the remaining 98 patients receiving traditional sterile gauze intervention were selected as group B. The incidence of infection and related complications, phlebitis, inflammatory factors, pain at the infusion site, nursing comfort and satisfaction, and quality of life were analyzed and compared between the two groups. Results It was found that compared with group B, the postoperative central venous catheter infection rate and the incidence of phlebitis were significantly lower in group A. In addition, the inflammatory response of patients in group A was better relieved. Moreover, the nursing comfort and satisfaction and the quality of life of patients in group A were significantly improved. Conclusion This study suggests that the Kanghuier transparent hydrocolloid dressing is effective in the prevention and treatment of central venous catheter infection and phlebitis in patients after heart surgery.
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Clinical features in proven and probable invasive fungal disease in children and adolescents at a pediatric referral center: a 5-year experience. World J Pediatr 2019; 15:270-275. [PMID: 31011987 DOI: 10.1007/s12519-019-00259-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/12/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is limited information concerning the overall epidemiology of invasive fungal disease (IFD) in children. The aim of this study was to clarify the clinical features of IFD in a tertiary pediatric care hospital. METHODS Patients diagnosed with proven or probable IFD at our hospital between 2011 and 2015 were retrospectively reviewed. Proven and probable IFD were defined according to the European Organization for Research and Treatment of Cancer/Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group consensus. Patients with possible IFD were excluded. RESULTS The incidence of proven or probable IFD was 26 of 20,079 hospitalized patients (0.13%). The predominant underlying disease was malignancy (54%) and congenital anomaly (27%). The most common diagnosis was candidemia among the patients with proven IFD (8 of 13, 62%). All the isolated pathogens in the candidemia patients were non-albicans Candida spp. The most common site of infection was the lungs in patients with probable IFD (11 of 13 patients, 85%). In probable IFD episodes, positive β-D-glucan and galactomannan were found in 12 of 13 (92%) and 5 of 13 (38%) patients, respectively. All but one patient (96%) received empirical antifungal therapy. No patients underwent surgical resection of residual lesions. The overall mortality was 23% and the attributable mortality of IFD was 12%. CONCLUSION Our results suggest the emergence of non-albicans Candida species as important pathogens in childhood IFD.
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Jaworski R, Haponiuk I, Irga-Jaworska N, Steffens M, Chojnicki M, Paczkowski K, Zielinski J. Monitoring both procalcitonin and C-reactive protein in the early period after tetralogy of Fallot correction in children promotes rational antibiotic use. Adv Med Sci 2018; 63:112-118. [PMID: 29111402 DOI: 10.1016/j.advms.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/20/2017] [Accepted: 10/17/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE This retrospective cohort study aimed to identify the early postoperative kinetics of C-reactive protein (CRP) and procalcitonin (PCT) in children undergoing tetralogy of Fallot (ToF) correction. The ability of these inflammatory markers to guide rational antibiotic usage was also determined. MATERIALS AND METHODS All consecutive children who underwent ToF correction in 2009-2016 in our referral pediatric cardiac surgery clinic in Gdansk, Poland and did not exhibit infection signs on early postoperative days (POD) were identified. All patients received 48h antibiotic prophylaxis. Antibiotic treatment was extended or empirical antibiotic therapy was introduced if the clinician considered it necessary. CRP and PCT levels were measured on POD1-4 and 1-3, respectively. RESULTS Of the 60 eligible children, 44 underwent CRP testing only. The remaining 16 patients underwent both CRP and PCT testing. All patients had abnormally high CRP values after surgery. All patients who also underwent PCT testing also displayed elevated PCT levels. The CRP and PCT levels peaked on POD2 (median=99.8mg/L) and POD1 (median=4.08ng/mL), respectively. In the CRP-alone patients, antibiotic prophylaxis was prolonged or empirical antibiotic therapy was started in 59%; in the CRP and PCT group, this was 25% (p<0.05). CONCLUSIONS The children had elevated CRP and PCT levels after ToF correction, with peaks observed on POD2 and POD1, respectively. Monitoring both CRP and PCT in the early postoperative period may guide antibiotic therapy, thus reducing unnecessary treatment, additional toxicity, and adverse drug interactions without increasing treatment failure. Rational antibiotic treatment may also reduce antibiotic resistance.
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Abstract
BACKGROUND Perioperative infections have significant consequences for children with congenital heart disease (CHD), which can manifest as acute or chronic infection followed by poor growth and progressive cardiac failure. The consequences include delayed or higher-risk surgery, and increased postoperative morbidity and mortality. METHODS A systematic search for studies evaluating the burden and interventions to reduce perioperative infections in children with CHD was undertaken using PubMed. RESULTS Limited studies conducted in low- to middle-income countries demonstrated the large burden of perioperative infections among children with CHD. Most studies focussed on infections after surgery. Few studies evaluated strategies to prevent preoperative infection or the impact of infection on decision-making around the timing of surgery. Children with CHD have multiple risk factors for infections including delayed presentation, inadequate treatment of cardiac failure, and poor nutrition. CONCLUSIONS The burden of perioperative infections is high among children with CHD, and studies evaluating the effectiveness of interventions to reduce these infections are lacking. As good nutrition, early corrective surgery, and measures to reduce nosocomial infection are likely to play a role, practical steps can be taken to make surgery safer.
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King J, Pana ZD, Lehrnbecher T, Steinbach WJ, Warris A. Recognition and Clinical Presentation of Invasive Fungal Disease in Neonates and Children. J Pediatric Infect Dis Soc 2017; 6:S12-S21. [PMID: 28927201 PMCID: PMC5907856 DOI: 10.1093/jpids/pix053] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Invasive fungal diseases (IFDs) are devastating opportunistic infections that result in significant morbidity and death in a broad range of pediatric patients, particularly those with a compromised immune system. Recognizing them can be difficult, because nonspecific clinical signs and symptoms or isolated fever are frequently the only presenting features. Therefore, a high index of clinical suspicion is necessary in patients at increased risk of IFD, which requires knowledge of the pediatric patient population at risk, additional predisposing factors within this population, and the clinical signs and symptoms of IFD. With this review, we aim to summarize current knowledge regarding the recognition and clinical presentation of IFD in neonates and children.
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Affiliation(s)
- Jill King
- Aberdeen Fungal Group, Medical Research Council Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, and the Royal Aberdeen Children’s Hospital, United Kingdom
| | - Zoi-Dorothea Pana
- Hospital Epidemiology and Infection Control, Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, Maryland
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; and
| | - William J Steinbach
- Division of Pediatric Infectious Diseases, Department of Pediatrics, and Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina
| | - Adilia Warris
- Aberdeen Fungal Group, Medical Research Council Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, and the Royal Aberdeen Children’s Hospital, United Kingdom
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Mycobacterium chimaera - a new threat for cardiac surgical patients? POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:22-26. [PMID: 28515744 PMCID: PMC5404123 DOI: 10.5114/kitp.2017.66925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/09/2017] [Indexed: 11/17/2022]
Abstract
An outbreak of invasive Mycobacterium chimaera infections associated with "heater-cooler" devices in patients treated with cardiac surgery has been described worldwide. The authors summarize the current state of knowledge regarding the epidemiology, diagnostics, treatment, and prevention of Mycobacterium chimaera infections in patients after cardiothoracic surgery.
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Abad C, Urso S, López-Ruiz JÁ, Tena MÁ, Serna J, Feijoo-Osorio JJ. Lethal Fournier gangrene following cardiac surgery with cardiopulmonary bypass. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 87:94-95. [PMID: 27986558 DOI: 10.1016/j.acmx.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cipriano Abad
- Service of Cardiac Surgery, University Hospital Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain.
| | - Stefano Urso
- Service of Cardiac Surgery, University Hospital Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - José Ángel López-Ruiz
- Service of Cardiac Surgery, University Hospital Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - María Ángeles Tena
- Service of Cardiac Surgery, University Hospital Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - Jaime Serna
- Service of Cardiac Surgery, University Hospital Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - Juan José Feijoo-Osorio
- Service of Cardiac Surgery, University Hospital Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
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Jaworski R, Irga-Jaworska N, Naumiuk Ł, Chojnicki M, Haponiuk I. Fournier Gangrene Caused by Candida albicans in an Infant After Cardiac Surgery. Mycopathologia 2016; 182:409-412. [PMID: 27807668 PMCID: PMC5344938 DOI: 10.1007/s11046-016-0086-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/24/2016] [Indexed: 11/27/2022]
Abstract
Fournier gangrene is a rare, rapidly progressive, life-threatening condition. We report a 23-day-old boy with pulmonary atresia and ventricular septal defect treated surgically, who developed Fournier gangrene. Emergency surgery was performed with tissue sampling for microbiological examination. Candida albicans was confirmed; caspofungin followed by fluconazole was administered with excellent results.
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Affiliation(s)
- Radoslaw Jaworski
- Department of Pediatric Cardiac Surgery, Copernicus Hospital in Gdansk, Al. Jana Pawla II 50, 80-462, Gdansk, Poland.
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, ul. Debinki 7, 80-210, Gdansk, Poland
| | - Łukasz Naumiuk
- Department of Clinical Microbiology, Hospital of the Medical University of Gdansk, ul. Debinki 7, 80-952, Gdansk, Poland
| | - Maciej Chojnicki
- Department of Pediatric Cardiac Surgery, Copernicus Hospital in Gdansk, Al. Jana Pawla II 50, 80-462, Gdansk, Poland
| | - Ireneusz Haponiuk
- Department of Pediatric Cardiac Surgery, Copernicus Hospital in Gdansk, Al. Jana Pawla II 50, 80-462, Gdansk, Poland.,Chair of Physiotherapy, Department of Rehabilitation and Kinesiology, Gdansk University of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336, Gdansk, Poland
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