1. Cumulative corticosteroid exposure and infection risk after complex pediatric cardiac surgery.
- Author
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Mastropietro CW, Barrett R, Davalos MC, Zidan M, Valentine KM, Delius RE, and Walters HL 3rd
- Subjects
- Academic Medical Centers, Adrenal Cortex Hormones administration & dosage, Bacterial Infections etiology, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures mortality, Cardiopulmonary Bypass methods, Child, Preschool, Cohort Studies, Confidence Intervals, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Heart Defects, Congenital diagnosis, Hospital Mortality trends, Humans, Incidence, Infant, Infant, Newborn, Infusions, Intravenous, Intraoperative Care methods, Length of Stay, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Postoperative Complications epidemiology, Postoperative Complications etiology, Preoperative Care methods, Retrospective Studies, Risk Assessment, Survival Rate, Adrenal Cortex Hormones adverse effects, Bacterial Infections epidemiology, Cardiac Surgical Procedures methods, Heart Defects, Congenital mortality, Heart Defects, Congenital surgery
- Abstract
Background: Children undergoing cardiac surgery may receive corticosteroids preoperatively to temper cardiopulmonary bypass-related inflammation, postoperatively for hemodynamic instability, and periextubation to reduce airway edema. Recent data have associated preoperative corticosteroids with infection. We aimed to determine if there is a relationship between cumulative corticosteroid exposure and infection., Methods: A retrospective review of children who underwent cardiac surgery at our institution from January 2009 to July 2010 was performed. To limit study heterogeneity, patients who were 5 years or younger with basic Aristotle score of 7 or higher and intensive care unit stay of 7 days or more were included. Infections during the first 30 postoperative days were recorded, defined as clinically relevant positive blood, urine, respiratory, or wound cultures, or culture-negative sepsis treated with 7 or more days of antimicrobial therapy. Multivariate logistic regression analysis was performed to determine independent risk factors for infection., Results: Seventy-six patients were reviewed. All patients received intraoperative methylprednisolone, 48% received postoperative hydrocortisone, and 86% received periextubation dexamethasone. Twenty-six patients (36%) had 58 infections. On univariate analysis, patients with infection had greater median comprehensive Aristotle score (14.5 [intraquartile range (IQR): 12.5 to 16] versus 11.5 [IQR: 10 to 13.1], p = 0.001), maximum vasoactive inotrope score (29 [IQR: 24 to 40] versus 24 [IQR: 17 to 31], p = 0.031, days endotracheally intubated (12 [IQR: 7 to 30] versus 5 [IQR: 4 to 6.5], p < 0.001), and days of corticosteroid exposure (7 [IQR: 5 to 12] versus 4 [IQR: 2 to 5), p < 0.001). Also, patients with infections more often underwent delayed sternal closure (p = 0.008). On multivariate analysis, days endotracheally intubated (p = 0.023) and days of corticosteroid exposure (p = 0.015) remained significant., Conclusions: For children undergoing complex cardiac surgery, greater cumulative duration of corticosteroid exposure is independently associated with postoperative infection., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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