先天性心脏病患儿心脏手术后医院获得性感染的危险因素和发生率:一项单中心经验。

Nimet Cındık, Mahmut Gökdemir, Mehmet Çelik, Asım Çağrı Günaydın
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引用次数: 0

摘要

背景:在儿科心胸重症监护室的危重儿童中,医院获得性感染(HAI)的流行病学研究较少。本研究旨在探讨先天性心脏病(CHD)儿童心脏手术后HAI的独立危险因素和发病率。方法:我们的研究包括574名在2016年9月至2020年12月期间接受先天性心脏手术并在心胸重症监护室接受随访的患者。所有患者根据年龄分为四组:0-1个月、1-6个月、6-12个月和1-18岁,并根据HAI的发展分为两个亚组。结果:患者手术时的中位年龄和体重分别为3.28(四分位间距[IQR]):0.43-8.1)个月和4.34(IQR:4.34-6.69)kg。分别在223名和21名患者中观察到HAI和感染相关死亡。手术时的年龄、手术时的体重、伴随的综合征和免疫缺陷状态、是否存在发绀型心脏病、插管和住院期间的抗生素使用在有和没有感染的两组之间具有统计学意义(p<0.05)。在逻辑回归分析中,手术重量<5kg(比值比[OR]:2.55;95%置信区间[CI]:1.56-4.17;p<0.001),术前机械通气(OR:2.0;95%CI:1.26-3.12;p=0.003),根据风险调整后的先天性心脏手术分类评分3的心脏手术复杂性(OR:3.13;95%CI:1.24-7.92;p=0.016),是否存在伴随综合征(OR:1.56;95%CI:1.02-2.88;p=0.040),年龄(OR:1.01;95%CI:1.01-1.04;p=0.044)是CHD儿童心脏手术后HAI的独立危险因素。结论:在本研究中,年龄较小、存在相关综合征、术前机械通气和体重小于5kg是CHD儿童心脏手术后HAI的独立危险因素。
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Risk factors for and incidence of hospital-acquired infections after cardiac surgery in children with congenital heart disease: a single center experience.

Background: The epidemiology of hospital-acquired infections (HAIs) has been less well studied in critically ill children in pediatric cardiothoracic intensive care units. This study aimed to investigate independent risk factors for and incidence of HAIs after cardiac surgery in children with congenital heart disease (CHD).

Methods: Our study included 574 patients who underwent congenital heart surgery and were followed up in the cardiothoracic intensive care unit between September 2016 and December 2020. All patients were divided into four groups according to age: 0-1 months, 1-6 months, 6-12 months, and 1-18 years, and into two subgroups according to HAI development.

Results: The patients` median age and weight at surgery were 3.28 (interquartile range [IQR]): 0.43-8.1) months and 4.34 (IQR: 4.34-6.69) kg, respectively. HAIs and infection-related deaths were observed in 223 and 21 patients, respectively. Age at surgery, weight at surgery, concomitant syndromes and immunodeficiency status, presence of cyanotic heart disease, intubation, and use of antibiotics during hospitalization were statistically significant between the two groups with and without infection (p < 0.05). In logistic regression analysis, surgical weight < 5 kg (odds ratio [OR]: 2.55; 95% confidence interval [CI]: 1.56-4.17; p < 0.001), preoperative mechanical ventilation (OR: 2.0; 95% CI: 1.26-3.12; p=0.003), complexity of cardiac surgery according to the risk-adjusted congenital heart surgery classification score 3 (OR: 3.13; 95% CI: 1.24-7.92; p=0.016), presence of an concomitant syndrome (OR: 1.56; 95% CI: 1.02-2.88; p=0.040), age (OR: 1.01; 95% CI: 1.01-1.04; p=0.044) were independent risk factors for HAIs after cardiac surgery in children with CHD.

Conclusions: In this study, younger age, presence of an associated syndrome, preoperative mechanical ventilation, and weight less than 5 kg were found to be independent risk factors for HAI after cardiac surgery in children with CHD.

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