3 results
Infection profile of patients with extracorporeal membrane oxygenation in paediatric cardiac surgery ICU
- Mehmet Emirhan Işık, Ergin Arslanoğlu, Şirin Menekşe, Yeşim Uygun-Kızmaz, Ömer Faruk Şavluk, Kenan Abdurrahman Kara, Aysu Türkmen-Karaağaç, Hakan Ceyran
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 11 / November 2022
- Published online by Cambridge University Press:
- 28 April 2022, pp. 1833-1838
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Aim:
We investigated the risk of increased nosocomial infections and the associated pathogens in patients who underwent paediatric cardiovascular surgery and were put on extracorporeal membrane oxygenation support. We studied the duration of extracorporeal membrane oxygenation use and other variables that may be associated with increased nosocomial infection risk.
Methods:Patients who were treated with an extracorporeal membrane oxygenation in paediatric cardiovascular surgery ICU between 2010 and 2020 were included in this retrospective study. We analysed the site of infection and microbiological profile of infections occurring in these patients according to CDC and National Healthcare Safety Network criteria.
Results:The onset of infection development in patients after extracorporeal membrane oxygenation was found to be median 8 (3–15, 25–75 IQR) days in the whole group, and median 11 (3–16, 25–75 IQR) days in those who developed infection without being put on extracorporeal membrane oxygenation. When patients were divided into those with and without infection, duration of ICU was found to be 19 (16–28, IQR 25–75) days in patients with infection vs. 8 (2–16, IQR 25–75; p: <0.001) days in patients without infection. Duration of extracorporeal membrane oxygenation support was found to be 14 (10–25, IQR 25–75) days in patients with infection versus 5 (2–10, IQR 25–75; p: <0.001) days in patients without infection and total hospital stay was 26 (18–33, IQR 25–75) days in patients with infection versus 8 (2–23, IQR 25–75) days in those without infection. A total of 24 patients out of the 70 patients experienced 32 infectious episodes during extracorporeal membrane oxygenation support. Culture-positive infections were detected at a single site in 19 patients, and multiple sites in 5 patients.
Conclusion:We propose that prolonged extracorporeal membrane oxygenation support is associated with an increased risk of infection. Although extracorporeal membrane oxygenation is a life-saving treatment method, prolonged extracorporeal membrane oxygenation may increase the development of infectious complications and the associated mortality and morbidity of the patient.
A 5-year analysis of Candida bloodstream infections in the paediatric cardiovascular surgery ICU of a tertiary care centre
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- Aysu Türkmen Karaağaç, Ömer Faruk Şavluk, Ayşe İnci Yıldırım
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- Journal:
- Cardiology in the Young / Volume 33 / Issue 2 / February 2023
- Published online by Cambridge University Press:
- 10 March 2022, pp. 301-305
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Background:
Candida infections have become one of the most common causes of morbidity and mortality in paediatric ICUs, especially following complex surgeries, all over the world. Therefore, we conducted a 5-year analysis of Candida bloodstream infections in our tertiary paediatric cardiovascular surgery ICU.
Methods:One thousand nine hundred and thirty four children, 0–16-year-old, who underwent paediatric cardiovascular surgery between January 2016–June 2021 were enrolled in this retrospective study. Blood cultures obtained from 1056 patients, who needed mechanical ventilation and indwelling devices longer than 5 days and had the signs of infection according to Center for Disease Control criteria, were evaluated. The isolated pathogens were recorded. 137 with Candida bloodstream infections were reanalysed for their age, weight, cardiac pathologies, duration of mechanical ventilation, hospitalisation and antibiotic use.
Results:One hundred and thirty-seven out of one thousand and fifty six patients (12.9%) had Candida growth in their blood cultures. C. albicans (n: 50, 36.5%), C. parapsilosis (n: 20, 14.6%), C. tropicalis (n: 8, 5.8%), C. glabrata (n: 5, 3.7%), and other non-albicans Candida species (n: 54, 39.4%) were isolated. The patients with Candida bloodstream infections had lower age, longer duration of mechanical ventilation, longer length of hospital stay and antibiotic use (p-values<0.05). They had cardiac pathologies as atrioventricular septal defect (18.9%), transposition of great arteries (17.6%), tetralogy of Fallot (12.4%), transposition of great arteries + double outlet right ventricle, or total anomalous pulmonary venous return + atrioventricular septal defect (37.9%), and others. The Candida bloodstream infections mortality was 11.6% (16/137).
Conclusion:The most common cause of Candida bloodstream infections in the last five years in our paediatric cardiovascular surgery ICU was non-albicans Candida species. Prolonged mechanical ventilation, hospitalisation and antibiotic use, low age, and weight were found as the main risk factors that raise the morbidity and mortality rates of Candida bloodstream infections.
How do diet and exercise programmes affect the cardiovascular risk profiles of obese children?
- Aysu Türkmen Karaağaç, Ayşe İnci Yıldırım
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- Journal:
- Cardiology in the Young / Volume 29 / Issue 2 / February 2019
- Published online by Cambridge University Press:
- 01 February 2019, pp. 200-205
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Obesity is a global health issue in both children and adults. Besides its comorbidities, cardiac structure and functions may be impaired from childhood if obesity is not controlled in the growing years. The effects of diet and exercise on the cardiovascular functions and biochemical parameters of obese children were evaluated in this study.
In a tertiary hospital, 6–16-year-old of mean age 10.8±2.3 years, non-random voluntarily selected 34 obese children with body mass index above 95th percentile and no syndromic or systemic illnesses were enrolled in this prospective study. Weights, heights, and blood pressures were recorded. Cardiac functions were evaluated by M-mode and tissue Doppler echocardiography. Glucose, HbA1c, cholesterol, triglyceride, liver enzyme, and thyroid hormone levels were analysed. These measurements were repeated after a 6-month diet and exercise programme. The results were compared statistically.
Echocardiography of the obese children after diet and exercise showed significantly increased ejection fraction, fractional shortening, mitral annular plane systolic excursion and mitral systolic velocity values, associated with the systolic ventricular functions, and decreased tissue Doppler mitral and tricuspid early diastolic velocities, related with the early diastolic ventricular functions, compared with before diet and exercise (p<0.05). Moreover, the body mass index, glucose, cholesterol, and triglyceride levels significantly decreased after diet and exercise (p<0.05).
The systolic and early diastolic cardiac functions are impaired and the biochemical parameters are distorted starting from the childhood because of the obesity. Regular diet and exercise provide significant improvement. Cardiac evaluation should be routinely performed in all obese children and they should be encouraged for a regular diet and exercise for better cardiovascular health.