The Incidence of Nosocomial Bloodstream Infections in Children With Congenital Heart Disease Undergoing Cardiac Surgery: A Retrospective Study
Abstract
Congenital heart disease (CHD) is the most common congenital abnormality in children and often requires surgical intervention. These children are vulnerable to nosocomial infections (NIs), particularly bloodstream infections (BSIs), after surgery. In this study, we aimed to investigate the incidence of bloodstream infections BSIs after cardiac surgery. This retrospective study was conducted on pediatric patients refered to Children’s Medical Center Hospital, affiliated with Tehran University of Medical Sciences, from March 2022 to March 2023 for cardiac surgery. The records of 449 patients were reviewed, with 436 meeting inclusion criteria. Data were extracted from medical records, including age, weight, gender, clinical diagnoses, and blood culture results. Statistical analysis was performed using descriptive statistics (including frequency, percentage, mean, and standard deviation) and inferential statistics (including Chi-square and Independent t-test) in SPSS version 23. The results showed that the incidence of BSIs in pediatric CHD patients after cardiac surgery was 3.21%. Postoperative blood cultures revealed that Klebsiella pneumoniae was the most common pathogen (42.9%), followed by Escherichia coli and Staphylococcus epidermidis (14.3% each). No significant association was found between BSIs and gender (P=0.70), weight (P=0.06), or diagnosis (P=0.44). However, age was significantly associated with BSI incidence (P<0.001). This study provides important insights into the incidence of nosocomial BSIs in pediatric CHD patients after cardiac surgery. Our results highlight the need for stronger infection control measures and targeted antibiotic therapies to effectively manage BSIs. Further research is recommended to validate these results and improve preventive measures in pediatric cardiac units.
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19. Ramakrishnan K, Venugopal J, Easow JM, Ravishankar M. Incidence, bacteriological profile and antibiotic resistance pattern of catheter associated urinary tract infections in a tertiary care hospital. J Pure Appl Microbiol 2019;13:1549-54.
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21. Buetti N, Marschall J, Drees M, Fakih MG, Hadaway L, Maragakis LL, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022;43:553-69.
22. Subbalakshmi E. Surveillance of Hospital Acquired Infection from Frequently Handled Surfaces in a Tertiary Care Teaching Hospital. Int J Curr Microbiol App Sci 2018;7:860-6.
23. Ashurst JV, Dawson A. Klebsiella Pneumonia. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC.; 2024.
24. Elhalik M, Habibullah J, El-Atawi K. Epidemiology of sepsis in NICU; A 12 years study from Dubai. J Pediatr Neonatal Care 2018;8:84-8.
25. Lyu ZY, Zhen JH, Meng QY, Zhou W, An JY, Dong F. Bacterial Etiology and Antimicrobial Resistance Pattern of Pediatric Bloodstream Infections in Beijing, 2015–2019. Infect Drug Resist 2023;16:6297-308.
26. Mueller M, Tainter CR. Escherichia coli Infection. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC.; 2024.
27. Liao WC, Chung WS, Lo YC, Shih WH, Chou CH, Chen CY, et al. Changing epidemiology and prognosis of nosocomial bloodstream infection: A single-center retrospective study in Taiwan. J Microbiol Immunol Infect 2022;55:1293-300.
28. Tian L, Sun Z, Zhang Z. Antimicrobial resistance of pathogens causing nosocomial bloodstream infection in Hubei Province, China, from 2014 to 2016: a multicenter retrospective study. BMC Public Health 2018;18:1-8.
29. Severn MM, Horswill AR. Staphylococcus epidermidis and its dual lifestyle in skin health and infection. Nat Rev Microbiol 2023;21:97-111.
30. Skovdal SM, Jørgensen NP, Meyer RL. JMM profile: Staphylococcus epidermidis. J Med Microbiol 2022;71:001597.
31. Luzzaro F, Ortisi G, Larosa M, Drago M, Brigante G, Gesu G. Prevalence and epidemiology of microbial pathogens causing bloodstream infections: results of the OASIS multicenter study. Diagn Microbiol Infect Dis 2011;69:363-9.
32. Seni J, Mwakyoma AA, Mashuda F, Marando R, Ahmed M, DeVinney R, et al. Deciphering risk factors for blood stream infections, bacteria species and antimicrobial resistance profiles among children under five years of age in North-Western Tanzania: a multicentre study in a cascade of referral health care system. BMC Pediatr 2019;19:32.
33. Mohamed AA, Haftu H, Hadgu A, Seyoum D, Gebrekidan G, Ebrahim MM, et al. Prevalence, Clinical Profile and Risk Factors of Nosocomial Infection in Ayder Pediatric Intensive Care Unit, Tigray, Ethiopia. Int J Gen Med 2022;15:7145-53.
2. Orchard J, Suna J, Renner A, Gordon L, McCarthy L, Pool N, et al. Wound management across Australian and New Zealand pediatric cardiac services: a cross-sectional survey. Cardiol Young 2024;34:1432-8.
3. Wang X, Li S, Huo D, Zhu Z, Wang W, He H, et al. Nosocomial Infections After Pediatric Congenital Heart Disease Surgery: Data from National Center for Cardiovascular Diseases in China. Infect Drug Resist 2024;17:1615-23.
4. Arpan S, Kalyan R, Mainak C, Karunakaran G. Correlation between Antimicrobial Resistance and Nosocomial Infections, their Prevention and Control. J Young Pharm 2020;12:25.
5. Kajiyazdi M, Dasdar S, Kianfar N, Kaveh M. Nosocomial Infection Surveillance in Neonatal Intensive Care Units of Bahrami Children’s Hospital. Arch Pediatr Infect Dis 2021;9:e108840.
6. Jia H, Li L, Li W, Hou T, Ma H, Yang Y, et al. Impact of Healthcare-Associated Infections on Length of Stay: A Study in 68 Hospitals in China. Biomed Res Int 2019;2019:2590563.
7. Yu X, Chen M, Liu X, Chen Y, Hao Z, Zhang H, et al. Risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease. BMC Infect Dis 2020;20:64.
8. Bychinin MV, Antonov IO, Klypa TV, Mandel IA, Minets AI, Kolyshkina NA, Golobokova YB. Nosocomial infection in patients with severe and critical COVID-19. Gen Reanimatol 2022;18:4-10.
9. Li L, Huang H. Risk factors of mortality in bloodstream infections caused by Klebsiella pneumonia: A single-center retrospective study in China. Medicine (Baltimore) 2017;96:e7924.
10. Almazeedi MA, Al Ghadeer HA, Bugshan AS, Alhrthi HL, Alshuaibi MK, Albarqi HH, et al. Pattern and Frequency of Nosocomial Infections in the Pediatric Intensive Care Unit at East Jeddah General Hospital, Saudi Arabia. Cureus 2023;15:e47561.
11. Bennett EE, VanBuren J, Holubkov R, Bratton SL. Presence of invasive devices and risks of healthcare-associated infections and sepsis. J Pediatr Intensive Care 2018;7:188-95.
12. Shariat M, Youssefkhani AB, Dalili H, Hajinasab N, Farrokhzad N, Nozarian Z, et al. Associated Factors and Common Pathogens of Positive Cultures in Infants With Definitive Septicemia Admitted to NICU. Acta Med Iran 2023;61:355-60.
13. Ting JY, Autmizguine J, Dunn MS, Choudhury J, Blackburn J, Gupta-Bhatnagar S, et al. Practice summary of antimicrobial therapy for commonly encountered conditions in the neonatal intensive care unit: a Canadian perspective. Front Pediatr 2022;10:894005.
14. Gidey K, Gidey MT, Hailu BY, Gebreamlak ZB, Niriayo YL. Clinical and economic burden of healthcare-associated infections: A prospective cohort study. Plos one 2023;18:e0282141.
15. Dashti AS, Kadivar MR, Tabatabai A, Zand F, Salami S, Ezadpanah S, et al. Prevalence of Healthcare-Associated Infections in Pediatric Wards of Nemazee Teaching Hospital in Shiraz: A Comparison with the Whole Hospital. Arch Pediatr Inf Dis 2019;7:e83488.
16. Patil RK, Kabera B, Muia CK, Ale BM. Hospital acquired infections in a private paediatric hospital in Kenya: a retrospective cross-sectional study. Pan Afr Med J. 2022;41:28.
17. Murni IK, Duke T, Kinney S, Daley AJ, Wirawan MT, Soenarto Y. Risk factors for healthcare-associated infection among children in a low-and middle-income country. BMC Infect Dis 2022;22:406.
18. Mustafa ZU, Khan AH, Salman M, Harun SN, Meyer JC, Godman B, et al. Healthcare-associated infections among neonates and children in Pakistan: findings and the implications from a point prevalence survey. J Hosp Infect 2023;141:142-51.
19. Ramakrishnan K, Venugopal J, Easow JM, Ravishankar M. Incidence, bacteriological profile and antibiotic resistance pattern of catheter associated urinary tract infections in a tertiary care hospital. J Pure Appl Microbiol 2019;13:1549-54.
20. Kubde D, Badge AK, Ugemuge S, Shahu S. Importance of Hospital Infection Control. Cureus 2023;15:e50931.
21. Buetti N, Marschall J, Drees M, Fakih MG, Hadaway L, Maragakis LL, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022;43:553-69.
22. Subbalakshmi E. Surveillance of Hospital Acquired Infection from Frequently Handled Surfaces in a Tertiary Care Teaching Hospital. Int J Curr Microbiol App Sci 2018;7:860-6.
23. Ashurst JV, Dawson A. Klebsiella Pneumonia. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC.; 2024.
24. Elhalik M, Habibullah J, El-Atawi K. Epidemiology of sepsis in NICU; A 12 years study from Dubai. J Pediatr Neonatal Care 2018;8:84-8.
25. Lyu ZY, Zhen JH, Meng QY, Zhou W, An JY, Dong F. Bacterial Etiology and Antimicrobial Resistance Pattern of Pediatric Bloodstream Infections in Beijing, 2015–2019. Infect Drug Resist 2023;16:6297-308.
26. Mueller M, Tainter CR. Escherichia coli Infection. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC.; 2024.
27. Liao WC, Chung WS, Lo YC, Shih WH, Chou CH, Chen CY, et al. Changing epidemiology and prognosis of nosocomial bloodstream infection: A single-center retrospective study in Taiwan. J Microbiol Immunol Infect 2022;55:1293-300.
28. Tian L, Sun Z, Zhang Z. Antimicrobial resistance of pathogens causing nosocomial bloodstream infection in Hubei Province, China, from 2014 to 2016: a multicenter retrospective study. BMC Public Health 2018;18:1-8.
29. Severn MM, Horswill AR. Staphylococcus epidermidis and its dual lifestyle in skin health and infection. Nat Rev Microbiol 2023;21:97-111.
30. Skovdal SM, Jørgensen NP, Meyer RL. JMM profile: Staphylococcus epidermidis. J Med Microbiol 2022;71:001597.
31. Luzzaro F, Ortisi G, Larosa M, Drago M, Brigante G, Gesu G. Prevalence and epidemiology of microbial pathogens causing bloodstream infections: results of the OASIS multicenter study. Diagn Microbiol Infect Dis 2011;69:363-9.
32. Seni J, Mwakyoma AA, Mashuda F, Marando R, Ahmed M, DeVinney R, et al. Deciphering risk factors for blood stream infections, bacteria species and antimicrobial resistance profiles among children under five years of age in North-Western Tanzania: a multicentre study in a cascade of referral health care system. BMC Pediatr 2019;19:32.
33. Mohamed AA, Haftu H, Hadgu A, Seyoum D, Gebrekidan G, Ebrahim MM, et al. Prevalence, Clinical Profile and Risk Factors of Nosocomial Infection in Ayder Pediatric Intensive Care Unit, Tigray, Ethiopia. Int J Gen Med 2022;15:7145-53.
| Files | ||
| Issue | Vol 62 No 4 (2024) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/acta.v62i4.17436 | |
| Keywords | ||
| Cardiac surgery Children Congenital heart disease Incidence Nosocomial infections | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Rajabi MM, Gharib B, Mirzaaghayan MR. The Incidence of Nosocomial Bloodstream Infections in Children With Congenital Heart Disease Undergoing Cardiac Surgery: A Retrospective Study. Acta Med Iran. 2024;62(4):227-232.
