{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:02:09Z","timestamp":1779778929235,"version":"3.53.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Nosocomial infections (NIs) following cardiac surgery in children with congenital heart disease (CHD) remain a significant contributor to morbidity, mortality, and prolonged hospital stays. This study aimed to identify independent risk factors for NI and to evaluate the predictive utility of the Systemic Immune-Inflammation Index (SII) in this high-risk population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>This was a single-center, retrospective observational study involving patients who underwent cardiovascular surgery between January 2015 and March 2025 and remained hospitalized for &amp;gt;\u200948\u2005h. NI was defined based on the Center for Disease Control's National Healthcare Safety Network (CDC\/NHSN) criteria. Multivariate logistic regression analysis using the \u2018backward conditional\u2019 method was performed to determine independent predictors of NI. Baseline and postoperative SII were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 209 children were included in the study. NIs were observed in 46 patients (22.0%), with sepsis (69.6%) and pneumonia (30.4%) being the most frequent types. Gram-negative bacteria (58.4%) predominated. Patients with NI were significantly younger, more frequently had cyanotic CHD, comorbidities, and higher Aristotle scores. Univariate analysis showed that postoperative SII was significantly lower in the infection group (562.73 vs. 916.28;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). However, multivariate analysis identified four independent predictors of increased NI risk; younger age (risk decreased by 2.2% per month: OR\u2009=\u20090.978, 95% CI\u2009=\u20090.957\u20130.999,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.041), mechanical ventilation duration (risk increased by 1.2% per hour: OR\u2009=\u20091.012, 95% CI\u2009=\u20091.00\u20131.024,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.047), postoperative length of stay (LOS) (risk increased by 16.2% per day: OR\u2009=\u20091.162, 95% CI\u2009=\u20091.031\u20131.309,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014), and presence of postoperative complications (risk increased\u223c110-fold: OR\u2009=\u2009110.365, 95% CI\u2009=\u20098.042\u20131514.674,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Postoperative SII did not retain a strong independent predictive value in the multivariate model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Postoperative complications are the strongest independent predictor for NIs following pediatric cardiac surgery. Prolonged mechanical ventilation and postoperative LOS significantly increase this risk. While SII correlates with infection status negatively, it does not function as a robust independent predictor in this patient population, possibly due to the overwhelming inflammatory response induced by cardiopulmonary bypass. These findings underscore the need for stringent infection control and aggressive management of postoperative morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1735292","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T06:02:36Z","timestamp":1779775356000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of nosocomial infections after congenital heart surgery in children: a comprehensive analysis including the systemic immune-inflammation index"],"prefix":"10.3389","volume":"14","author":[{"given":"Sercan","family":"Tak","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tu\u011fba Bedir","family":"Demirda\u011f","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Department of Pediatrics, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erkan","family":"\u0130riz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eda Nur","family":"Yi\u011fiter","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issa Aden Ahmed","family":"Shide","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhan","family":"Mammadov","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An\u0131l","family":"Tap\u0131s\u0131z","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Department of Pediatrics, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma Hayvac\u0131","family":"Canbeyli","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutlu Uysal","family":"Yaz\u0131c\u0131","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebru","family":"Azapa\u011fas\u0131","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Gazi University Faculty of Medicine","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/j.athoracsur.2009.11.048","article-title":"Major infection after pediatric cardiac surgery: a risk estimation model","volume":"89","author":"Barker","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e14279","DOI":"10.7717\/peerj.14279","article-title":"Major infections following pediatric cardiac surgery pre- and 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