Risk factors for nosocomial infections after cardiac surgery in newborns with congenital heart disease
Risk factors for nosocomial infections after cardiac surgery in newborns with congenital heart disease
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DOI：
10.1016/j.pedneo.2017.11.014
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发表时间：
2018-08-01
影响因子：
2.1
通讯作者：
Miranda-Novales, Guadalupe
中科院分区：
文献类型：
--
作者：
Garcia, Heladia;Cervantes-Luna, Beatriz;Miranda-Novales, Guadalupe
背景：先天性心脏病是最常见的先天畸形之一。大约50%的先天性心脏病患者接受心脏手术。医院感染（NI）是先天性心脏病的主要并发症，也是导致发病率和死亡率增加的重要原因。本研究的目的是确定先天性心脏病新生儿心脏手术后发生 NI 的相关危险因素。 方法：这是一项巢式病例对照研究，纳入 112 名新生儿，其中 56 例（有 NI）和 56 例对照（无 NI）。分析的变量包括围产期病史、相关先天性畸形、风险调整先天性心脏病手术 (RACHS-1) 评分、围手术期和术后因素、输血、中心静脉导管长度、营养支持和机械通气。统计分析：使用Mann-Whitney-U 检验、Pearson X-2 或Fisher 精确检验计算差异。采用多因素logistic回归分析确定独立危险因素。结果：脓毒症是最常见的NI（37.5%），主要致病微生物为革兰阳性球菌。与NI相关的独立危险因素为非心脏先天畸形（OR 6.1，CI 95% 1.3-29.4）、中心静脉导管留置时间> 14天（OR 3.7，CI 95% 1.3-11.0）、机械通气时间> 7天（OR 6.6，CI 95% 2.1-20.1）和>= 5输注血液制品（OR 3.1，CI 95% 1.3-8.5）。 NI 导致的死亡率为 17.8%。结论：患有非心脏先天性畸形且机械通气 >7 天的新生儿发生术后 NI 的风险较高。工作重点必须集中在可预防的感染上，特别是血流导管相关感染，占所有感染的 20.5%。版权所有 (C) 2017，台湾儿科医学会。由爱思唯尔台湾有限公司出版。
Background: Congenital heart diseases are among the most common congenital malformations. Approximately 50% of the patients with congenital heart disease undergo cardiac surgery. Nosocomial infections (NIs) are the main complications and an important cause of increased morbidity and mortality associated with congenital heart diseases. This study's objective was to identify the risk factors associated with the development of NIs after cardiac surgery in newborns with congenital heart disease.Methods: This was a nested case-control study that included 112 newborns, including 56 cases (with NI) and 56 controls (without NI). Variables analyzed included perinatal history, associated congenital malformations, Risk-Adjusted Congenital Heart Surgery (RACHS-1) score, perioperative and postoperative factors, transfusions, length of central venous catheter, nutritional support, and mechanical ventilation. Statistical analysis: Differences were calculated with the Mann-Whitney-U test, Pearson X-2, or Fisher's exact test. A multivariate logistic regression was used to determine the independent risk factors.Results: Sepsis was the most common NI (37.5%), and the main causative microorganisms were gram-positive cocci. The independent risk factors associated with NI were non-cardiac congenital malformations (OR 6.1, CI 95% 1.3-29.4), central venous catheter indwelling time > 14 days (OR 3.7, CI 95% 1.3-11.0), duration of mechanical ventilation > 7 days (OR 6.6, CI 95% 2.1-20.1), and >= 5 transfusions of blood products (OR 3.1, CI 95% 1.3-8.5). Mortality attributed to NI was 17.8%.Conclusion: Newborns with non-cardiac congenital malformations and with >7 days of mechanical ventilation were at higher risk for a postoperative NI. Efforts must focus on preventable infections, especially in bloodstream catheter-related infections, which account for 20.5% of all NIs. Copyright (C) 2017, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC.