Health-care associated infections in children after cardiac surgery in a pediatric cardiac intensive care unit (PCICU).

Key words: health-care associated infections (HAIs); cardiac intensive care unit (CICU); pediatric cardiac surgery Copyright © 2011 Siddiqui et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Health-care associated infection (HAI) represents a major complication in patients undergoing cardiac surgery [1]. In the hospital setting of developing countries, where sub-optimal infection control and resource utilization may adversely affect surgical outcome, HAI rates are predictably higher (e.g 49% in India) than those in developed countries where rates range from 5.5% to 30.8% [2,3,4,5]. We report the frequency of HAIs and the associated case fatality rate among post-cardiac surgery pediatric patients admitted to the cardiac intensive care unit (CICU), at The HAI frequency in our study cohort was 7.9% (26/329). The low incidence of HAIs in our study, compared to the Indian cohort [5], may reflect strict implementation and adherence to the institutional Infection Control (IC) policy including strict visit regulations (one parent at a time), hand hygiene and an 1:1 nurse-to-patient ratio in high dependency/intensive care areas. An inverse correlation between HAI rates and nursing hours to patient day ratio had been reported in a previous cohort [2]. Table 1 elaborates demographic features, risk factors, and common sites of infection in descending order of frequency for our group of patients [4]. Though Gram-negative bacteria comprised 62.5% of all isolates (25/40), coagulase-negative staphylococci (CoNS) were the most prevalent pathogens overall (9/40) (Table 2). The case-fatality rate (CFR) for pediatric post-cardiac surgery HAIs was 19.2% (5/26) while the overall mortality rate was only 6.0% (20/329). This four-fold difference reflects the 10-fold difference reported by Grisaru-Soen et al. [4]. Though age (< 1 month), complex congenital heart disease, higher complexity score (RACHS->3), and bloodstream infection (BSI) have all been reported as risk factors for mortality among post-cardiac surgery children with HAIs, the small size of our sample may have been responsible for not finding them significant [4]. In conclusion, although the frequency of pediatric post-cardiac surgery HAIs in our cardiac intensive care unit in Karachi, Pakistan, is lower than that reported in prior studies, case-fatality rates are comparable. Large prospective cohort studies may be required to identify population and age specific risk factors for HAI-related mortality in our hospital.