RESUMO
Se realizó un estudio prospectivo, observacional, analítico con el objetivo de evaluar la influencia de determinados factores sobre el desarrollo de infecciones nosocomiales en pacientes sometidos a cirugía cardíaca en el Cardiocentro Pediátrico William Soler durante 2006. Fueron estudiadas variables preoperatorias, intraoperatorias y posoperatorias en los grupos de pacientes con infección nosocomial y sin infección nosocomial. De 228 pacientes, 26 (11.4%) presentaron 43 episodios de IN (tasa de episodios de IN = 18.9). Los principales factores de riesgo fueron: nutrición parenteral, [OR: 27.8 (IC 95%: 9.4-81.7)], categoría 4 de RACHS-1 [RR: 17 (IC 95%: 3.17-91.27) reintubación traqueal [OR: 10.3(IC 95%: 3.3-32.4)], antibioticoterapia preoperatoria [OR:9.0 (IC 95%: 2.1-38.5), volumen de hemoderivados> de 50 ml/kg [RR: 7.9 (IC 95%; 3.3-18.9); p = 0.000],sonda vesical = 7 días [RR: 6.7 (IC 3.4-13.4); p = 0.002],catéter venoso central = 7 días [RR: 5.7 (IC 95%;2.7-12.2); p = 0.004] y tiempo de pinzamiento aórtico> de 100 minutos [RR: 5.0 (IC 95%; 2.2-11.5); p = 0.018].La nutrición parenteral, un elevado puntaje de complejidad quirúrgica (RACHS-1), reintubación traqueal, uso de antibioticoterapia preoperatoria y la transfusión masivade hemoderivados fueron las variables asociadas a los más elevados riesgos de infección nosocomial.
Objective: to assess de influence of risk factors on the development of nosocomial infections in patients subjected to cardiac surgery. Design: A prospective, 1 year study. Setting: A pediatric cardiac surgery service, national referral center. Subjects: All patients whounderwent cardiac surgery from January 1, 2006, to December 31, 2006 were enrolled, except patients whodied the first 48 hours after surgery or those with evidenceof infection at o not survived. Interventions: None. Measurement and main results: Preoperative, intraoperativeand postoperative variables were compared between patients who developed nosocomial infections and those patients who did not. Out of 228 patients, 26(11.4%) developed at least one episodes of nosocomial infections. The main risk factors were: parenteral nutrition[RR: 27.8 (95% CI: 9.4-81.7)], category 4 of RACHS-1score [RR: 17 (95% CI: 3.17-91.27), tracheal reintubation[RR: 10.3 (95% CI: 3.3-32.4)], preoperative antibiotic use[RR: 9.0 (95% CI: 2.1-38.5), blood products transfusion> de 50 ml/kg [RR: 7.9 (95% CI: 3.3-18.9); p = 0.000], urinary catheter = 7 days [RR: 6.7 (95% CI: 3.4-13.4);p = 0.002], central venous catheter = 7 days [RR: 5.7(95% CI: 2.7-12.2); p = 0.004], and aortic clamp time> 100 minutes [RR: 5.0 (95% CI: 2.2-11.5); p = 0.018]. Conclusions: Parenteral nutrition, high score of RACHS-1, tracheal reintubation, preoperative antibiotic therapy andmassive transfusion were the variables associated with the higher risks of nosocomial infections.