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Bloodstream infections after median sternotomy at a children's hospital
Samir S Shah1, Jessica Kagen, Ebbing Lautenbach
1Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. shahs@email.chop.edu
Insights
Postoperative bloodstream infections occurred in 6.3% of children after median sternotomy. Mediastinitis and extracorporeal membrane oxygenation were identified as key risk factors.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Postoperative bloodstream infections (BSIs) are a significant cause of morbidity and increased healthcare costs.
- Mediastinitis is a known risk factor for BSIs in adult populations.
Purpose of the Study:
- To determine the incidence of postoperative BSIs in children following median sternotomy.
- To identify risk factors associated with BSIs in this pediatric cohort.
Main Methods:
- A retrospective cohort study was conducted.
- 192 pediatric patients undergoing median sternotomy between 1995 and 2003 were analyzed.
Main Results:
- The incidence of BSIs within 30 days post-sternotomy was 6.3%.
- Mediastinitis (OR, 28.16) and the need for extracorporeal membrane oxygenation (OR, 12.52) were significantly associated with BSIs.
- Gram-negative bacilli were the most common cause of BSIs.
Conclusions:
- Postoperative mediastinitis and extracorporeal membrane oxygenation are significant risk factors for BSIs in children after median sternotomy.
- These findings suggest a need for further investigation in larger, multicenter studies.
Objectives:
Postoperative bloodstream infections are a major source of morbidity and increased health care costs. In adults, mediastinitis has been described as a risk factor for bloodstream infections. The objectives of this retrospective cohort study were to determine the incidence and to identify risk factors for postoperative bloodstream infections among children after median sternotomy in an urban tertiary care children's hospital.
Methods:
For this study, 192 patients were randomly selected from among all patients undergoing median sternotomy between January 1, 1995, and December 31, 2003.
Results:
Ninety-eight (51%) of the 192 eligible patients were male. The median patient age was 5.4 months (interquartile range: 1 day-41.5 years). Bloodstream infections occurred in 12 (6.3%; 95% confidence interval [CI]: 3.3%-10.7%) patients within the first 30 days after median sternotomy. Bloodstream infections developed a median of 11 days (range: 3-29 days) after median sternotomy. Gram-negative bacilli caused 6 (50%) of the 12 bloodstream infections. Specific causes of bloodstream infections included Pseudomonas aeruginosa (n = 3), coagulase-negative staphylococci (n = 3), Pseudomonas fluorescens-putida (n = 2), Staphylococcus aureus (n = 2), Serratia marcescens (n = 1), and Candida albicans (n = 1). Multivariable analysis revealed that the development of mediastinitis (odds ratio [OR], 28.16; 95% CI, 3.37-235.22) and the requirement for postoperative extracorporeal membrane oxygenation (OR, 12.52; 95% CI, 2.99-52.41) were associated with bloodstream infections after median sternotomy.
Conclusions:
Postoperative bloodstream infections occurred in 6.3% of children undergoing median sternotomy. Postoperative mediastinitis and the requirement for extracorporeal membrane oxygenation were risk factors for bloodstream infections after median sternotomy. These findings warrant exploration in a larger, multicenter study.
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