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Sternal wound and mediastinal infections in infants with congenital heart disease
1Division of Pediatrics, The Cleveland Clinic Children's Hospital, OH 44195, USA.
Insights
Sternal wound and mediastinal infections in infants undergoing congenital heart surgery are often caused by Staphylococcus. These infections can be chronic, leading to delayed surgical repair.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Cardiology
Background:
- Congenital heart disease (CHD) necessitates palliative or repair procedures in infants.
- Sternal wound and mediastinal infections (SWMI) are serious complications following cardiac surgery in neonates.
- Early diagnosis and management of SWMI are crucial for patient outcomes.
Purpose of the Study:
- To delineate the epidemiologic, clinical, bacteriologic, and therapeutic characteristics of SWMI in infants.
- To identify risk factors and clinical presentations of SWMI in neonates undergoing CHD surgery.
- To evaluate treatment strategies and outcomes for SWMI in this vulnerable population.
Main Methods:
- Retrospective chart review of seven infants diagnosed with SWMI post-CHD surgery.
- Analysis of patient demographics, surgical history, infection presentation, causative pathogens, and treatment regimens.
- Categorization of infections into superficial sternal or deep mediastinal types.
Main Results:
- All affected infants were under 30 days old at initial surgery; most had hypoplastic left heart syndrome.
- Superficial sternal infections presented earlier (mean 12 days post-op), while deep mediastinal infections were often asymptomatic until a second surgery (mean 120 days post-op).
- Staphylococcus aureus or coagulase-negative Staphylococcus was the predominant pathogen; all mediastinal infections required operative debridement and long-term antibiotics.
Conclusions:
- SWMI in infants undergoing staged palliative procedures for CHD can be chronic and indolent.
- Delayed diagnosis of deep mediastinal infections may occur due to asymptomatic presentation.
- Effective management involves prompt surgical debridement and prolonged antibiotic therapy, though repair delays are common.
Abstract:
The objective was to describe the epidemiologic, clinical, bacteriologic and therapeutic features of seven infants who developed sternal wound and mediastinal infections following palliation and/or repair procedures for congenital heart disease. A retrospective chart review was used. All infants with sternal wound and mediastinal infections were < 30 days of age at the initial operative procedure. Six of the infants had hypoplastic left heart syndrome, and one had complete transposition. Two infants required delayed closure of their chest wound. Three infants had superficial sternal infections and presented at a mean of 12 days postoperatively. Four infants had infection of the deep mediastinal structures: they were all asymptomatic and had purulent collections in their mediastinum at their second palliative operation, which was performed at a mean of 120 days after the initial surgery. Staphylococcus aureus, or coagulase-negative Staphylococcus, was isolated from the wound and/or blood of six infants. All infants with mediastinal infections were managed with operative debridement. Infants with superficial infections underwent local debridement. All infants received long-term intravenous antibiotics. Mediastinal infections in infants undergoing palliative staged procedures for congenital heart lesions may be chronic and indolent, resulting in delayed repair of congenital heart lesions.