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Open Access Research article

Postoperative differences between colonization and infection after pediatric cardiac surgery-a propensity matched analysis

Daniel J Lex1, Roland Tóth1, Zsuzsanna Cserép12, Tamás Breuer2, Erzsébet Sápi2, András Szatmári3, János Gál4 and Andrea Székely24*

Author Affiliations

1 School of PhD Studies, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary

2 Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Haller u. 29, 1096 Budapest, Hungary

3 Department of Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Haller u. 29, 1096 Budapest, Hungary

4 Department of Anesthesiology and Intensive Therapy, Semmelweis University, Kútvölgyi út 4, 1125 Budapest, Hungary

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Journal of Cardiothoracic Surgery 2013, 8:166  doi:10.1186/1749-8090-8-166

Published: 2 July 2013

Abstract

Background

The objective of this study was to identify the postoperative risk factors associated with the conversion of colonization to postoperative infection in pediatric patients undergoing cardiac surgery.

Methods

Following approval from the Institutional Review Board, patient demographics, co-morbidities, surgery details, transfusion requirements, inotropic infusions, laboratory parameters and positive microbial results were recorded during the hospital stay, and the patients were divided into two groups: patients with clinical signs of infection and patients with only positive cultures but without infection during the postoperative period. Using propensity scores, 141 patients with infection were matched to 141 patients with positive microbial cultures but without signs of infection. Our database consisted of 1665 consecutive pediatric patients who underwent cardiac surgery between January 2004 and December 2008 at a single center. The association between the patient group with infection and the group with colonization was analyzed after propensity score matching of the perioperative variables.

Results

179 patients (9.3%) had infection, and 253 patients (15.2%) had colonization. The occurrence of Gram-positive species was significantly greater in the colonization group (p = 0.004). The C-reactive protein levels on the first and second postoperative days were significantly greater in the infection group (p = 0.02 and p = 0.05, respectively). The sum of all the positive cultures obtained during the postoperative period was greater in the infection group compared to the colonization group (p = 0.02). The length of the intensive care unit stay (p < 0.001) was significantly longer in the infection group compared to the control group.

Conclusions

Based on our results, we uncovered independent relationships between the conversion of colonization to infection regarding positive S. aureus and bloodstream results, as well as significant differences between the two groups regarding postoperative C-reactive protein levels and white blood cell counts.

Keywords:
Colonization; Infection; Conversion; Risk factors; Pediatric; Cardiac surgery; Perioperative; Intensive care