Tweddell Sarah, Loomba Rohit S, Cooper David S, Benscoter Alexis L
Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Congenit Heart Dis. 2019 Sep;14(5):785-790. doi: 10.1111/chd.12779. Epub 2019 May 6.
Health care-associated infections (HAIs) increase mortality, length of stay, and cost in hospitalized patients. The incidence of and risk factors for developing HAIs in the pediatric population after cardiac surgery have been studied. This study evaluates the impact of HAIs on length of stay, inpatient mortality, and cost of hospitalization in the pediatric population after cardiac surgery.
The Kids' Inpatient Database was queried for analysis. Patients under 18 years of age who underwent cardiac surgery from 1997 to 2012 were included. HAIs were defined as central line-associated blood stream infections, catheter-associated urinary tract infections, ventilator-associated pneumonias, and surgical wound infections. Univariate analysis compared admissions with and without a HAI. Next, regression analysis was done to determine patient factors independently associated with a HAI, and to determine what specific HAIs were independently associated with our primary outcomes.
In total 46 169 admissions were included, 773 (1.6%) of which had a HAI. Regression analysis showed younger age (P < .001), heart failure (OR 1.2, 95% CI 1.1-1.4, P = .03), and acute kidney injury (AKI; 2.7, 2.0-3.6, P < .001), among others were all independently associated with a HAI. The presence of HAI was associated with increased length of stay (median 29 vs 6 days, P < .001), total cost (median $271 884 vs $88 385, P < .001), and inpatient mortality (6.1% vs 2.5%, P < .001) by univariate analysis. Regression analysis demonstrated that each HAI were independently associated with increased length of stay and increased total charges for the hospital stay. However, HAI, was not associated with increased mortality after regression analysis.
The incidence of HAIs in this analysis was low (1.6%) but contributed significantly to length of stay and cost. No individual HAI was associated with increased mortality. Potential modifiable risk factors include age and prevention of AKI.
医疗保健相关感染（HAIs）会增加住院患者的死亡率、住院时间和费用。小儿心脏手术后发生HAIs的发生率及危险因素已得到研究。本研究评估了HAIs对小儿心脏手术后住院时间、住院死亡率及住院费用的影响。
查询儿童住院数据库进行分析。纳入1997年至2012年接受心脏手术的18岁以下患者。HAIs定义为中心静脉导管相关血流感染、导尿管相关尿路感染、呼吸机相关性肺炎及手术切口感染。单因素分析比较了有无HAI的入院情况。接下来，进行回归分析以确定与HAI独立相关的患者因素，并确定哪些特定的HAIs与我们的主要结局独立相关。
共纳入46169例入院病例，其中773例（1.6%）发生HAI。回归分析显示，年龄较小（P <.001）、心力衰竭（OR 1.2，95%CI 1.1 - 1.4，P =.03）以及急性肾损伤（AKI；2.7，2.0 - 3.6，P <.001）等均与HAI独立相关。单因素分析显示，HAI的存在与住院时间延长（中位数29天对6天，P <.001）、总费用增加（中位数271884美元对88385美元，P <.001）及住院死亡率升高（6.1%对2.5%，P <.001）相关。回归分析表明，每种HAI均与住院时间延长及住院总费用增加独立相关。然而，回归分析后HAI与死亡率升高无关。
本分析中HAIs的发生率较低（1.6%），但对住院时间和费用有显著影响。没有单一的HAI与死亡率增加相关。潜在的可改变危险因素包括年龄和预防AKI。
