Estudio prospectivo sobre factores de riesgo de infección nosocomial después de cirugía cardíaca pediátrica / Risk factors of nosocomial infections after pediatric cardiac surgery. Prospective study

RESUMEN

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 [OR9.0 (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.

ABSTRACT

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.