Risk factors and risk adjustment for surgical site infections in pediatric cardiothoracic surgery patients.
BACKGROUND
The complexity of congenital cardiac defects and the aggressive medical management required to support patients through their recovery place children at high risk for surgical site infection (SSI).


METHODS
We conducted a retrospective review of children undergoing cardiothoracic surgery at a tertiary care referral center between January 1, 2000, and June 30, 2001. Preoperative, intraoperative, and postoperative data were assessed by multivariate analysis.


RESULTS
Of 726 surgical procedures performed in 626 patients, SSIs occurred after 46 procedures performed in 46 patients (6.3%). Infections were superficial (n = 22; 47.8%), deep tissue (n = 7; 15.2%), or organ space (n = 17; 37.0%), including 5 episodes of mediastinitis. Median time to SSI was 10 days; 36% of the infections were identified after discharge. On multivariate analysis, children with SSIs were more likely to have been <30 days old (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.2-70), to have a perioperative medical device, and to use parenteral nutrition (OR, 3.3; 95% CI, 1.4-7.9). Multiple severity of illness scores, the Risk Adjustment for Congenital Heart Surgery (RACHS-1) category, and longer duration of postoperative antimicrobials were not associated with SSI.


CONCLUSIONS
The use of perioperative medical interventions increases the risk of SSI in young children after cardiac surgery. Prolonged postoperative courses of antimicrobials should be avoided in the absence of documented infection.
Sohn
Annette H
AH
Division of Pediatric Infectious Diseases, University of California-San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA. sohna@peds.ucsf.edu
Schwartz
Jackie M
JM
Yang
Kathy Y
KY
Jarvis
William R
WR
Guglielmo
B Joseph
BJ
Weintrub
Peggy S
PS
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006331:Heart Diseases / Q000151:congenital* / Q000601:surgery*; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D011300:Preoperative Care / Q000009:adverse effects; D012189:Retrospective Studies; D020379:Risk Adjustment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013903:Thoracic Surgery
D000900:Anti-Bacterial Agents