Lex Daniel J, Tóth Roland, Cserép Zsuzsanna, Breuer Tamás, Sápi Erzsébet, Szatmári András, Gál János, Székely Andrea
School of PhD Studies, Semmelweis University, Budapest, Hungary.
J Cardiothorac Surg. 2013 Jul 2;8:166. doi: 10.1186/1749-8090-8-166.
The objective of this study was to identify the postoperative risk factors associated with the conversion of colonization to postoperative infection in pediatric patients undergoing cardiac surgery.
Following approval from the Institutional Review Board, patient demographics, co-morbidities, surgery details, transfusion requirements, inotropic infusions, laboratory parameters and positive microbial results were recorded during the hospital stay, and the patients were divided into two groups: patients with clinical signs of infection and patients with only positive cultures but without infection during the postoperative period. Using propensity scores, 141 patients with infection were matched to 141 patients with positive microbial cultures but without signs of infection. Our database consisted of 1665 consecutive pediatric patients who underwent cardiac surgery between January 2004 and December 2008 at a single center. The association between the patient group with infection and the group with colonization was analyzed after propensity score matching of the perioperative variables.
179 patients (9.3%) had infection, and 253 patients (15.2%) had colonization. The occurrence of Gram-positive species was significantly greater in the colonization group (p=0.004). The C-reactive protein levels on the first and second postoperative days were significantly greater in the infection group (p=0.02 and p=0.05, respectively). The sum of all the positive cultures obtained during the postoperative period was greater in the infection group compared to the colonization group (p=0.02). The length of the intensive care unit stay (p<0.001) was significantly longer in the infection group compared to the control group.
Based on our results, we uncovered independent relationships between the conversion of colonization to infection regarding positive S. aureus and bloodstream results, as well as significant differences between the two groups regarding postoperative C-reactive protein levels and white blood cell counts.
本研究的目的是确定接受心脏手术的儿科患者中，与定植转为术后感染相关的术后风险因素。
经机构审查委员会批准后，在患者住院期间记录患者人口统计学信息、合并症、手术细节、输血需求、血管活性药物输注情况、实验室参数和微生物检测阳性结果，并将患者分为两组：有感染临床体征的患者和术后仅培养结果阳性但无感染的患者。使用倾向评分法，将141例感染患者与141例微生物培养阳性但无感染体征的患者进行匹配。我们的数据库由2004年1月至2008年12月在单一中心接受心脏手术的1665例连续儿科患者组成。对围手术期变量进行倾向评分匹配后，分析感染患者组与定植患者组之间的关联。
179例患者（9.3%）发生感染，253例患者（15.2%）发生定植。定植组革兰阳性菌的发生率显著更高（p = 0.004）。感染组术后第1天和第2天的C反应蛋白水平显著更高（分别为p = 0.02和p = 0.05）。与定植组相比，感染组术后获得的所有阳性培养结果之和更大（p = 0.02）。与对照组相比，感染组的重症监护病房住院时间显著更长（p < 0.001）。
基于我们的研究结果，我们发现金黄色葡萄球菌阳性和血流结果方面，定植转为感染之间存在独立关系，并且两组在术后C反应蛋白水平和白细胞计数方面存在显著差异。
