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Gram-Negative Sepsis Following Operation for Congenital Heart Disease: Diagnosis, Management, and Results

Gram-Negative Sepsis Following Operation for Congenital Heart Disease: Diagnosis, Management, and... Abstract Twenty-four of a series of 540 patients undergoing operative treatment of congenital heart disease developed septicemia. In the 20 patients under 6 months of age, mechanical ventilation was used postoperatively; the signs and symptoms of sepsis were vague. One infant in this group is alive. In the four between the ages of 2 and 32 years, one was successfully treated by antibiotics, two required reoperation to replace prosthetic patches with autogenous pericardium, and one died from septic shock. Gram-negative bacteria, resistant to the "prophylactic" antibiotics used, were most commonly encountered. The source of sepsis was the lungs, the operative wound, or an intravenous catheter. In five cases, the source was not apparent. The study suggests that sepsis is a more common cause of death following cardiovascular operations in infants than had been realized. Infected intracardiac prostheses cannot be sterilized by antibiotics and must be removed. References 1. Altemeier WA, Todd JC, Inge WW: Gram-negative septicemia: A growing threat . Assoc Surg 166:530-542, 1967. 2. Linde LM, Heins HL: Bacterial endocarditis following surgery for congenital heart disease . New Eng J Med 263:65-69, 1960.Crossref 3. Gluck L, Wood HF, Fousek MD: Septicemia of the newborn . Pediat Clin N Amer 13:1131-1148, 1966. 4. Downes JJ, Nicodemus HF, Pierce WS, et al: Acute respiratory failure in infants following cardiovascular surgery . J Thorac Cardiovasc Surg 59:21-37, 1970. 5. Goodman JS, Schaffner W, Collins HA, et al: Infection after cardiovascular surgery . New Eng J Med 278:117-123, 1968.Crossref 6. Barney JD, Williams GR, Cayler GG, et al: Influence of intracardiac prosthetic materials on susceptibility to bacterial endocarditis , abstracted. Circulation 26:684, 1962. 7. Wilmore DW, Dudrick SJ: Safe long-term venous catheterization . Arch Surg 98:256-258, 1969.Crossref 8. Geraci JE, Dale AJD, McGoon DC: Bacterial endocarditis and endarteritis following cardiac operations . Wisconsin Med J 62:302-315, 1963. 9. Martin WJ: Bacteremia and bacteremic shock in surgical patients . Surg Clin N Amer 49:1053-1070, 1969. 10. The symposium on gentamicin , editorial. J Infect Dis 119:537-540, 1970. 11. Brumfitt W, Percival A, Leigh DA: Clinical and laboratory studies with carbenicillin . Lancet 1:1289-1293, 1967.Crossref 12. Smith CB, Dans PE, Wilfert JN, et al: Use of gentamicin in combination with other antibiotics . J Infect Dis 119:370-377, 1969.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Gram-Negative Sepsis Following Operation for Congenital Heart Disease: Diagnosis, Management, and Results

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Publisher
American Medical Association
Copyright
Copyright © 1970 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1970.01340300054010
Publisher site
See Article on Publisher Site

Abstract

Abstract Twenty-four of a series of 540 patients undergoing operative treatment of congenital heart disease developed septicemia. In the 20 patients under 6 months of age, mechanical ventilation was used postoperatively; the signs and symptoms of sepsis were vague. One infant in this group is alive. In the four between the ages of 2 and 32 years, one was successfully treated by antibiotics, two required reoperation to replace prosthetic patches with autogenous pericardium, and one died from septic shock. Gram-negative bacteria, resistant to the "prophylactic" antibiotics used, were most commonly encountered. The source of sepsis was the lungs, the operative wound, or an intravenous catheter. In five cases, the source was not apparent. The study suggests that sepsis is a more common cause of death following cardiovascular operations in infants than had been realized. Infected intracardiac prostheses cannot be sterilized by antibiotics and must be removed. References 1. Altemeier WA, Todd JC, Inge WW: Gram-negative septicemia: A growing threat . Assoc Surg 166:530-542, 1967. 2. Linde LM, Heins HL: Bacterial endocarditis following surgery for congenital heart disease . New Eng J Med 263:65-69, 1960.Crossref 3. Gluck L, Wood HF, Fousek MD: Septicemia of the newborn . Pediat Clin N Amer 13:1131-1148, 1966. 4. Downes JJ, Nicodemus HF, Pierce WS, et al: Acute respiratory failure in infants following cardiovascular surgery . J Thorac Cardiovasc Surg 59:21-37, 1970. 5. Goodman JS, Schaffner W, Collins HA, et al: Infection after cardiovascular surgery . New Eng J Med 278:117-123, 1968.Crossref 6. Barney JD, Williams GR, Cayler GG, et al: Influence of intracardiac prosthetic materials on susceptibility to bacterial endocarditis , abstracted. Circulation 26:684, 1962. 7. Wilmore DW, Dudrick SJ: Safe long-term venous catheterization . Arch Surg 98:256-258, 1969.Crossref 8. Geraci JE, Dale AJD, McGoon DC: Bacterial endocarditis and endarteritis following cardiac operations . Wisconsin Med J 62:302-315, 1963. 9. Martin WJ: Bacteremia and bacteremic shock in surgical patients . Surg Clin N Amer 49:1053-1070, 1969. 10. The symposium on gentamicin , editorial. J Infect Dis 119:537-540, 1970. 11. Brumfitt W, Percival A, Leigh DA: Clinical and laboratory studies with carbenicillin . Lancet 1:1289-1293, 1967.Crossref 12. Smith CB, Dans PE, Wilfert JN, et al: Use of gentamicin in combination with other antibiotics . J Infect Dis 119:370-377, 1969.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Dec 1, 1970

References