Abou Elella Raja, Najm Hani K, Balkhy Hanan, Bullard Lily, Kabbani Mohamed S
Cardiac Sciences Department, King Abdulaziz Medical City, Mail Code 1413, PO Box 22490, Riyadh 11426, Saudi Arabia.
Pediatr Cardiol. 2010 May;31(4):483-9. doi: 10.1007/s00246-009-9624-x. Epub 2010 Jan 10.
Bloodstream infections (BSIs) are a main cause of nosocomial infection in the critical care area. The development of BSI affects the surgical outcome and increases intensive care unit (ICU) morbidity and mortality. This prospective cohort study was undertaken to determine the incidence, etiology, risk factors, and outcome of BSI for postoperative pediatric cardiac patients in the pediatric cardiac ICU setup. All postoperative pediatric patients admitted to the pediatric cardiac ICU from January 2007 to December 2007 were included in the study. Data were prospectively collected using a standardized data collection form. Patients with BSI (group 1) were compared with non-BSI patients (group 2) in terms of age, weight, surgical complexity score, duration of central line, need to keep the chest open postoperatively, and the length of the pediatric cardiac ICU and hospital stay. Of the 311 patients who underwent cardiac surgery during the study period, 27 (8.6%) were identified as having BSI (group 1). The 311 patients included in the study had a total of 1,043 central line days and a catheter-related BSI incidence density rate of 25.8 per 1,000 central line days. According to univariate analysis, the main risk factors for the development of BSI after pediatric cardiac surgery were lower patient weight (p = 0.005), high surgical complexity score (p < 0.05), open sternum postoperatively (p < 0.05), longer duration of central lines (p < 0.0001), and prolonged pediatric cardiac ICU and hospital stay (p < 0.0001). Gram-negative organisms were responsible for 67% of the BSI in the pediatric cardiac ICU, with pseudomonas (28%) and enterobacter (22%) as the main causative organisms. The mortality rate in the BSI group was 11% compared with 2% in the non-BSI group. In our pediatric cardiac ICU, BSI developed in 8.6% of the children undergoing cardiac surgery, mainly caused by a Gram-negative organism. The main risk factors for BSI in the postoperative pediatric cardiac patient were high surgical complexity, open sternum, low body weight, longer duration of central line, and prolonged pediatric cardiac ICU stay.
血流感染（BSIs）是重症监护区域医院感染的主要原因。血流感染的发生会影响手术结果，并增加重症监护病房（ICU）的发病率和死亡率。本前瞻性队列研究旨在确定小儿心脏重症监护病房中术后小儿心脏患者血流感染的发生率、病因、危险因素及转归。纳入2007年1月至2007年12月入住小儿心脏重症监护病房的所有术后小儿患者。使用标准化数据收集表前瞻性收集数据。将血流感染患者（第1组）与非血流感染患者（第2组）在年龄、体重、手术复杂程度评分、中心静脉置管时间、术后是否需要保持胸骨开放以及小儿心脏重症监护病房住院时间和住院总时长方面进行比较。在研究期间接受心脏手术的311例患者中，27例（8.6%）被确定发生了血流感染（第1组）。纳入研究的311例患者中心静脉置管总天数为1043天，导管相关血流感染的发病率密度为每1000个中心静脉置管日25.8例。单因素分析显示，小儿心脏手术后发生血流感染的主要危险因素为患者体重较低（p = 0.005）、手术复杂程度评分高（p < 0.05）、术后胸骨开放（p < 0.05）、中心静脉置管时间长（p < 0.0001）以及小儿心脏重症监护病房和住院时间延长（p < 0.0001）。革兰阴性菌导致了小儿心脏重症监护病房67%的血流感染，其中铜绿假单胞菌（28%）和肠杆菌（22%）为主要致病菌。血流感染组的死亡率为11%，而非血流感染组为2%。在我们的小儿心脏重症监护病房，8.6%接受心脏手术的儿童发生了血流感染，主要由革兰阴性菌引起。术后小儿心脏患者发生血流感染的主要危险因素为手术复杂程度高、胸骨开放、体重低、中心静脉置管时间长以及小儿心脏重症监护病房住院时间延长。
