Abstract
Objective – to assess the risk factors for colonization of non-sterile loci by gram-negative carbapenem-resistant bacteria, to analyze its effect and the effect of other factors of the perioperative period on the development of infectious complications in initially colonized patients with congenital heart defects (CHD).
Material and methods. Screening for colonization with Gram-negative carbapenem-resistant bacteria was performed in 549 children aged 0 to 12 months with risk factors for infectious complications (emergency hospitalization, transfer from other hospitals, antibiotic therapy in the previous 90 days) admitted for surgical treatment for CHD. Swabs from the pharynx and rectum were taken from each patient for microbiological examination no later than 72 hours after admission (a total of 1098 samples). The study group included 51 colonized patients; the control group included an equal number of matched non-colonized patients with risk factors randomly selected in the same time interval.
Results. A history of antibacterial therapy increased the chance of developing pathological colonization (odds ratio (OR) 1.41; 95% confidencial interval (CI) 1.78–9.42, p<0.01). Infectious complications in the study group developed in 32 (62.7%) patients, in the control group – in 17 (33.3%) patients (p=0.005). Initial colonization by Gram-negative carbapenem-resistant bacteria (OR 3.37; 95% CI 1.49– 7.59, p=0.005), presence of CHD with enrichment of pulmonary blood flow (OR 2.87; 95% CI 1.28–6.42, p=0.011), stay in the intensive care unit (ICU) over 5.5 days (OR 8,52; 95% CI 3.49–20.78, p<0.001), artificial lung ventilation over 68.5 hours (OR 5.7; 95% CI 2.39– 13.62, p<0.001), the presence of a central venous catheter (CVC) over 8.5 days (OR 28.83; 95% CI 9.91–83.83, p<0.001) increased the risk of infectious complications. The median development of infectious complications in patients of the study group was 4 (3–7) days, and in the control group 7.5 (4–13.5) days, p=0.02. In colonized patients, the duration of stay in the ICU and the duration of ventilation before the development of infectious complications were less than in patients without initial colonization (cut-off points of 4.5 days and 56.3 hours, respectively, versus 6.5 days and 97.4 hours, respectively). The threshold values of the duration of CVC standing before the development of infectious complications did not differ in initially colonized patients and patients without colonization (cut-off point of 8.5 days).
Conclusion. The main risk factor for colonization with Gram-negative carbapenem-resistant bacteria is a history of antibacterial therapy. Colonization with carbapenem-resistant Gram-negative bacteria, the presence of CHD with enrichment of the pulmonary blood flow, prolonged stay in the ICU, prolonged mechanical ventilation, and prolonged use of the CVC increases the risk of developing infectious complications of any etiology.
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About the authors
- Dmitry A. Popov, Dr. Med. Sci., Professor RAS, Head of Laboratory; ORCID
- Regina A. Osokina, Clinical Pharmacologist; ORCID
- Tatyana Yu. Vostrikova, Cand. Med. Sci., Clinical Microbiologist; ORCID
- Vyacheslav Yu. Beketovskiy, Anesthesiologist & Intensivist, Head of Department; ORCID
- Anton A. Atmashkin, Junior Researcher, Cardiovascular Surgeon; ORCID
- Nadezhda M. Shishkina, Cardiologist; ORCID
