发展中国家先天性心脏病手术项目中的术后感染：来自国际质量改进协作组的数据。
Postoperative Infection in Developing World Congenital Heart Surgery Programs: Data From the International Quality Improvement Collaborative.
作者信息
Sen Amitabh Chanchal, Morrow Debra Forbes, Balachandran Rakhi, Du Xinwei, Gauvreau Kimberlee, Jagannath Byalal R, Kumar Raman Krishna, Kupiec Jennifer Koch, Melgar Monica L, Chau Nguyen Tran, Potter-Bynoe Gail, Tamariz-Cruz Orlando, Jenkins Kathy J
机构信息
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.).
出版信息
Circ Cardiovasc Qual Outcomes. 2017 Apr;10(4). doi: 10.1161/CIRCOUTCOMES.116.002935.
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%; <0.001), as were postoperative ventilation duration (80 versus 14 hours; <0.001) and intensive care unit stay (216 versus 68 hours; <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.
背景
术后感染是先天性心脏病手术后发病和死亡的重要原因，且往往是可预防的。我们利用来自发展中国家先天性心脏病手术国际质量改进协作组的数据，试图确定术后感染的危险因素以及对先天性心脏手术后结局的影响。
方法与结果
纳入了2010年至2012年期间在16个发展中国家的27个参与机构进行的小儿心脏手术病例。在机构访视期间对关键变量进行审核。对人口统计学、术前、手术过程、手术复杂性和结局数据进行分析。采用单因素和多因素逻辑回归来确定感染的危险因素，包括细菌性败血症和手术部位感染，以及其他临床结局。计算标准化感染率以跟踪随时间的进展。在14545例病例中，793例（5.5%）发生细菌性败血症，306例（2.1%）发生手术部位感染。感染病例的院内死亡率显著高于未感染病例（16.7%对5.3%；<0.001），术后通气时间（80小时对14小时；<0.001）和重症监护病房停留时间（216小时对68小时；<0.001）也是如此。手术时年龄较小、手术复杂性较高、氧饱和度较低和患有重大内科疾病是感染的独立危险因素。与2010年相比，2011年的总体标准化感染率为0.65（95%置信区间，0.58 - 0.73），2012年为0.59（95%置信区间，0.54 - 0.64）。
结论
术后感染是先天性心脏病手术后死亡和发病的原因。年龄较小、病情较复杂的患者风险尤其高。针对感染风险的质量改进可能会降低发展中国家的发病率和死亡率。
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