الفهرس 
CROHN’S DISEASEOnly 14 pages are availabe for public view
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Abstract
ABSTRACT
Background: Nosocomial infections (NI) also termed as healthcare-associated infections (HCAIs) include infections that are acquired from a hospital or other health care centers, which appear for the first time within 48 hours of hospital admission, 3 days of discharge or 30 days of operation. However, in some cases, the NIs occur within 30 days after discharge, such as surgical site infections.
Aim of the Work: Primary aim: Identifying the frequency and risk factors of major and minor infection in the early postoperative course of pediatric cardiac surgery.
Secondary aim: Identifying the most prevalent isolated microorganisms and the antimicrobial susceptibility pattern. Tertiary aim: Highlighting the points of improvement to reduce the incidence of post-operative infection in the center of study.
Patients and Methods: This study is a prospective cohort observational study and conducted on patients who were admitted at post-operative Cardiac Pediatric Intensive Care Unit at Ain Shams University Hospitals over 6 months from May 2022 to November 2022.
Results: Our study included 60 pediatric patients (32 males and 28 females) who underwent cardiac surgical intervention for congenital heart disease with ages ranging from 1 to 168 months and a median age of 30 months (IQR between 12 and 108 months). Our study found that out of 60 patients, 15% had postoperative major infections, 13.3% had minor infections and the rest (71.7%) developed neither major nor minor infection during the early post-operative period. Our study found that the most common risk factors of infection (either major or minor) were the long duration on mechanical ventilation , central venous catheterization and postoperative need for blood transfusion (packed RBCs, plasma, PLT transfusion) . In our study, About 350 collected samples (blood ,urine ,sputum, BAL fluid ,surgical wound swaps and central line samples ) out of 60 patient were done then blood culture , central line culture, sputum culture, urine culture, surgical wound culture and culture of bronchoalveolar lavage fluid were done by using these samples . Out of them 23 culture results were positive ( incidence 6.5%) . The most common isolated gram positive organism was staph aureus (incidence 1.1%) and the most common isolated gram negative organism were Klebsiella ssp (incidence 2.2%) followed by acintobater cepacia ( incidence 1.4%) then E. coli (incidence 1.1%). no isolation of fungal infection. Regarding antimicrobial susceptibility pattern of these microorganisms , Our study found that, Out of 4 S. Aureus infected patients, 3 were sensitive to Meropenem and Imipenem, 4 were sensitive to Vancomycin and Linezolid. Out of 8 Klebsiella pneumoniae infected patients, 6 were sensitive to Meropenem and 7 to Imipenem. The two AC. Baumannii infected patients were sensitive to Minocycline. Out of 4 E. coli infected patients, 2 were sensitive to Meropenem, Imipenem, Cefotaxime and Amikacin, 4 were sensitive to Ceftazidime and Metronidazole, 3 were sensitive to Ceftriaxone. So, by this study, the ability to decrease the risk factors of major and minor infections, early diagnosis of the type of organism responsible for nosocomial infection and early treatment with suitable antibiotics will decrease the incidence rate of post-operative infections.
Conclusion: Major postoperative infections caused adverse outcomes in pediatric cardiac surgery and associated with high mortality rates and longer hospital stay. Blood components transfusions, duration of mechanical ventilation and central venous catheterization were associated with higher rates of nosocomial infections.