Surgical-site infections in infants undergoing surgery for congenital heart disease during their first year of life

Objectives: Infants undergoing cardiothoracic surgery for congenital heart disease (CHD) are at risk for surgical-site infections (SSIs). Two widely used surveillance systems, the Society of Thoracic Surgeons (STS) and the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN), use different surveillance definitions for SSIs. Thus, we compared SSIs meeting STS and NHSN case definitions; evaluated SSI trends; identified risk factors; determined outcomes; and described causative pathogens. Methods: From January 2020 to December 2023, we conducted a retrospective cohort study of infants undergoing cardiothoracic surgery during their first year of life at a single academically affiliated children's hospital in New York City. We calculated the number of SSIs identified using STS versus NHSN definitions; assessed demographic characteristics and pre-, intra-, and postoperative risk factors for SSIs using multivariable logistic regression; and assessed susceptibility to cefazolin perioperative prophylaxis. Results: During the study period, 867 infants underwent 1126 procedures. Sixty-one (7.0%) infants experienced SSIs identified by STS surveillance, of which 25 (41.0%) SSIs did not meet NHSN surveillance definitions. SSI rates showed a nonsignificant downward trend during the study period. Independent risk factors for SSIs were cyanotic lesions, hospitalization >7 days before surgery and surgical duration ≥5 hours. Infants with SSIs had longer hospitalizations and greater all-cause, in-hospital mortality. Twenty-seven (44.3%) SSIs included pathogens resistant to cefazolin. Conclusions: Young infants undergoing surgery for CHD are at risk for SSIs. National alignment of SSI surveillance definitions is needed to more accurately capture burden and inform targeted prevention in high-risk infants.