Septic emboli caused by vascular catheters after surgery for congenital heart disease

Objective: To review the incidence, diagnosis, and management of septic emb oli caused by vascular catheters after surgery for congenital heart disease . Design: Retrospective clinical review. All patients were computer registere d. Our database includes daily follow-up and every sign of infection regist ered. Setting: Pediatric cardiac surgery intensive care unit in a university hosp ital. Patients: A total of 720 consecutive pediatric cardiac operations performed in 108 neonates and 612 older children from 1995 to 1997 are reviewed. Measurements and Main Results: Septic emboli were defined as erythematous n on-tender papulonodular hemorrhagic lesions restricted to the limb and dist al to the monitoring catheter. Four patients (0.55%) with catheter-related septic emboli after congenital heart surgery were identified, three neonate s (0.41%) and one older infant (0.14%). The incidence of catheter-related s eptic emboli in our patients was significantly higher in the neonatal group compared with cider infants (p = .0076; odds ratio = 17.45). All infants with catheter-associated septic emboli were severely ill and re quired prolonged intensive care management postoperatively for periods rang ing from 27 to 90 days (mean, 50 days). The catheters involved were in plac e for periods ranging from 5 to 7 days. All patients were treated by cathet er removal and intravenous antibiotics without surgical intervention in the vascular access area. The affected limbs healed well without residual dama ge. Conclusions: Septic emboli are a rare complication of infected vascular cat heters in neonates and small infants undergoing prolonged postoperative int ensive care management (0.55%). They may indicate the source of unexplained sepsis involving mainly Gram-negative bacilli. Generally, treatment consis ts of removal of the offending catheter and antibiotic administration with no need for surgical intervention.