Department of Pediatric Critical Care, Vanderbilt University Medical Center, Nashville, TN.
Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA.
Pediatr Crit Care Med. 2018 Sep;19(9):810-815. doi: 10.1097/PCC.0000000000001634.
To assess the prevalence of central line-associated bloodstream infections in pediatric patients with and without chylothorax after cardiac surgery and identify risk factors that predict those patients at highest risk for developing a central line-associated bloodstream infection.
Retrospective single-center cohort study.
A PICU located within a tertiary-care academic pediatric hospital.
All pediatric patients admitted to the PICU after cardiac surgery between 2008 and 2014.
None.
We identified 1,191 pediatric cardiac surgery patients in the study time frame, of which 66 (5.5%) had chylothorax. Patients with chylothorax were more likely to have a central line-associated bloodstream infection (23% vs 3.8%; p < 0.001). Patients with both chylothorax and central line-associated bloodstream infection had longer durations of central venous catheter, higher Risk Adjustment Congenital Heart Surgery score, longer PICU stay, and higher mortality compared with patients with chylothorax who did not have a central line-associated bloodstream infection. Multivariable analysis identified higher Risk Adjustment Congenital Heart Surgery score, longer duration of central venous catheter, and higher chest tube output at 24 hours after initiating treatment for chylothorax to be predictive of increased central line-associated bloodstream infection risk in patients with chylothorax.
The prevalence of central line-associated bloodstream infection is higher in pediatric patients with chylothorax after heart surgery. In patients with chylothorax, complexity of surgery, central venous catheter duration, and chest tube output are associated with increased risk for developing a central line-associated bloodstream infection. Using this knowledge will allow us to identify patients at increased risk for central line-associated bloodstream infections and to focus extra prevention efforts on them.
评估心脏手术后伴有和不伴有乳糜胸的儿科患者中心静脉相关血流感染的发生率，并确定预测这些患者发生中心静脉相关血流感染风险最高的因素。
回顾性单中心队列研究。
位于三级儿科学术医院的 PICU。
2008 年至 2014 年期间在 PICU 接受心脏手术后入住 PICU 的所有儿科患者。
无。
在研究时间范围内，我们确定了 1191 名儿科心脏手术患者，其中 66 名（5.5%）患有乳糜胸。患有乳糜胸的患者更有可能发生中心静脉相关血流感染（23%比 3.8%；p<0.001）。与患有乳糜胸但未发生中心静脉相关血流感染的患者相比，同时患有乳糜胸和中心静脉相关血流感染的患者的中心静脉导管使用时间更长、风险调整先天性心脏病手术评分更高、PICU 住院时间更长、死亡率更高。多变量分析确定，较高的风险调整先天性心脏病手术评分、中心静脉导管使用时间较长以及在开始治疗乳糜胸后 24 小时内的胸腔引流管引流量较高与乳糜胸患者中心静脉相关血流感染风险增加相关。
心脏手术后伴有乳糜胸的儿科患者中心静脉相关血流感染的发生率较高。在患有乳糜胸的患者中，手术的复杂性、中心静脉导管的使用时间和胸腔引流管的引流量与发生中心静脉相关血流感染的风险增加相关。利用这些知识，我们可以识别出发生中心静脉相关血流感染风险增加的患者，并将额外的预防措施集中在这些患者身上。
