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2015, Number S3

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Rev Med Inst Mex Seguro Soc 2015; 53 (S3)

Risk factors related to nosocomial pneumonia in pediatric patients undergoing heart surgery

Fortanelli-Rodríguez RE, Gómez-Delgado A, Vera-Canelo JM, Alvarado-Diez MÁ, Miranda-Novales G, Yuriko Furuya ME, Solórzano-Santos F, Vázquez-Rosales JG

Language: Spanish
References: 23
Page: 316-323
PDF size: 298.95 Kb.


ABSTRACT

Objective: Procalcitonin is a diagnostic marker useful to discern infections and non-infectious complications in heart surgeries. The aim is to describe risk factors related to nosocomial pneumonia and the predictive value of serum procalcitonin in pediatric patients undergoing heart surgery.
Methods: During a year a nested case control study was carried out in a third level hospital. All patients undergoing open-heart surgery were followed and clinical data searching for pneumonia were registered every day. Blood samples for determination of procalcitonin were taken 48 hours after surgery. Those patients who developed pneumonia based on CDC clinical criteria were defined as cases; and controls were those patients who did not developed pneumonia.
Results: 188 patients underwent heart surgery. Ninety-seven patients were submitted to open-heart surgery. Twenty-four were diagnosed with pneumonia and 73 were designed as controls. Seventy-eight % of cases developed pneumonia between second and fifth day after surgery. In multivariate analysis, open sternotomy, serum procalcitonin concentration › 1.7 mcg/mL were associated with the presence of pneumonia. The sensitivity of serum procalcitonin to predict the presence of pneumonia was 72 % with specificity of 79 %.
Conclusions: Open sternotomy, time during surgery, time of extracorporeal circulation, time of aortic clamp were trans-chirurgical risk factors associated to development of pneumonia. Procalcitonin concentration › 1.7 mcg/mL is independent associated to nosocomial pneumonia.


REFERENCES

  1. Ministerio de Salud. Guía clínica de cardiopatías congénitas operables en menores de 15 años . Primera edición. Santiago, Chile: Minsal; 2005.

  2. Ponce de León S, Molinar F, Dominguez G, Rangel S, Vázquez V. Prevalence of infections in intensive care units in México: A multicenter study. Crit Care Med. 2000;28:1316-21.

  3. Lodha R, Chandra U, Natchu M, Nanda M, Kabra S. Nosocomial infections in Pediatric intensive care. Indian J Pediatr. 2001;68:1063-70.

  4. Leal SR, Márquez JA, García-Curiel A, Camacho P, Rincón MD, Ordoñez A et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med. 2000;28:935-40.

  5. Tan L, Sun X, Zhu X, Zhang Z, Li J, Shu Q. Epidemiology of nosocomial pneumonia in infants alter cardiac surgery. Chest. 2004;125:410-7.

  6. Bouza E, Perez A, Muñoz P, Pérez J, Rincón C, Sánchez C, et al. Ventilator-associated pneumonia after heart surgery: A prospective analisys and the value of surveillance. Crit Care Med. 2003;31:1964-70.

  7. Mandankini P, Yatin M, Poonam K, Anshumali C, Vinay K, Naresh T. Ventilator-Associated Pneumonia: Incidence, Risk factors, outcome, and microbiology. J Cardiothorac Vasc Anesth. 2003;17:22-8.

  8. Fischer JE, Allen P, Fanconi S. Delay in extubation in neonates and children after cardiac surgery: impact of ventilator –associated penumonia. Intensive Care Med. 2000; 26:942-9.

  9. Carrel T, Eisinger E, Vogt M, Turina MI. Pneumonia after cardiac surgery is predictable by tracheal aspirates but cannot be prevented by prolonged antibiotic prophylaxis. Ann Thorac Surg. 2001;72:143-8.

  10. Malviya S, Voepel-Lewis T, Siewert M, Uma A, Riegger L, Tait Al. Risk factors for adverse postoperative outcomes in children presenting for cardiac surgery with upper respiratory tract infections. Anesthesiology. 2003;98:628-32.

  11. van Rossum AMC, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis. 2004;4:620-30.

  12. Dörge H, Schöndube F, Dörge P, Seipelt R, Voss M, Messmer B. Procalcitonin is a valuable prognostic marker in cardiac surgery but not specific for infection. Thorac Cardiov Surg. 2003;51:322-6.

  13. Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, et al. Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med. 2000;9:3171-6.

  14. Reith HB, Mittelkötter U, Debus ES, Küssner C, Thied A. Procalcitonin in Early Detection of Postoperative Complications. Digestive Surgery. 1998;15:260.

  15. Arkader R, Toster EJ, Monteiro Abellan D, Rezende Lopes M, Raiz Júnior R, Carcillo JA, et al. Procalcitonin and C-reactive protein kinetics in Postoperative Pediatric Cardiac Surgical Patients. J Cardiothorac Vasc Anesth. 2004;2:160-5.

  16. Topal AE, Eren MN. Risk factors for the development of pneumonia post cardiac surgery. Cardiovasc J Afr. 2012;23:212-5.

  17. Bautista B, de Leon N. Epidemiology of nosocomial penumonia among infants, children, and adolescents after cardiac surgery at philipine heart center. Chest. 2006;130:239s-240s.

  18. Jashiashvili N, Nanuashvili A. Hospital pneumonia following cardiac surgery in children. Georgian Med News. 2005;127:22-5.

  19. Lespron M. Respuesta inflamatoria sistémica en cirugía cardiaca. Arch Cardiol Mex. 2006;76:92-9.

  20. Shaath GA, Jijeh A, Faruqui F, Bullard L, Mehmood A, Kabbani MS. Ventilator-associated pneumonia in children afeter cardiac surgery. Pediatr Cardiol. 2014;35;627-31.

  21. Roeleveld P, Guijt D, Kuijper E, Hazekamp M, De Wilde R, Jonge E. Ventilator-associated pneumonia in children after cardiac surgery in The Netherlands. Intensive Care Med. 2011;37:1656-63.

  22. Tang C, Liu P, Huang Y, Pan J, Lee S, Hsieh K, et al. Ventilator-associated pneumonia after pediatric cardiac surgery in southern Taiwan. J Microbiol Immunol Infect. 2009;42:413-9.

  23. Sponholz C, Sakr Y, Reinhart K, Brunkhorst F. Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Critical Care. 2006;10:11-25.




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