Bacteremia in PCICU - are hand hygiene and prevention bundles is all about? a novel way of bacteremia prediction

Introduction

CLABSI is a well described burden in pediatric intensive care units(PICU). Patients being cared for in a dedicated pediatric cardiac ICU(PCICU) may have a different risk profile than those cared for in PICUs due to the younger age, the high incidence of surgical procedures, the inflammatory effects of cardiopulmonary bypass(CPB), and the frequent use of multiple invasive devices. We have noticed that high risk patients may develop BSI after an inciting event. The aim of this study was to find out whether high risk patients which developed bacteremia had more inciting events than in a similar group of high risk patients who didn`t develop bacteremia.

Methods

This was a retrospective case-control study. We enrolled data of patients who developed bacteremia from March 2010 to November 2019 after undergoing open heart surgery. The control group was comprised of case matched patients with the immediate consecutive same surgery. Operative data, common risk factors, post-operative severity of illness parameters, mortality, and inciting events 72hours before bacteremia emerged were recorded.

Results

A total of 200 patients were included (100 with bacteremia, and 100 controls). Main demographic and operative parameters were matched. Bacteremia emerged on average POD 12.8. Gram negative bacteria comprised 84%, Skin associated gram positive bacteria were cultured in 10% of the patients. Average CVL duration was 9.5(±8.4) days. Immediate post-operative(72 hours) severity of illness parameters were significantly worse in patients with bacteremia, as well as higher rate of post-operative complications. Ninety two inciting events (92%) were recorded 72hours prior the bacteremia, as compared to 21 events (21%) during the whole LOS of the control group(OR 43.3,CI 18.2-103.1,p<0.0001).

Conclusion

High risk patients undergoing open heart surgery have significant higher risk for bacteremia after an inciting event.