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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
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Impact of standardization of antimicrobial prophylaxis duration in pediatric cardiac surgery

Sundeep Bath1, Jason Lines2, Ann M Loeffler2

  • 1Pacific University, School of Pharmacy, Hillsboro, Ore; Randall Children's Hospital at Legacy Emanuel, Portland, Ore.

The Journal of Thoracic and Cardiovascular Surgery
|June 2, 2016
PubMed

Insights

Shortening antimicrobial prophylaxis to 48 hours after pediatric cardiac surgery did not increase surgical site infections. This study suggests a shorter duration is safe, but more research is needed for delayed sternal closure cases.

Area of Science:

  • Pediatric Cardiac Surgery
  • Infectious Disease Control
  • Clinical Protocol Optimization

Background:

  • The optimal duration of antimicrobial prophylaxis post-pediatric cardiac surgery remains debated.
  • Adult data suggest shorter prophylaxis durations are effective, but pediatric-specific evidence is limited.

Purpose of the Study:

  • To evaluate the impact of a restricted 48-hour antimicrobial prophylaxis protocol on surgical site infection (SSI) rates in pediatric cardiac surgery patients.
  • To identify risk factors for SSIs in this patient population.

Main Methods:

  • A quasi-experimental study analyzing patient charts (≤18 years) undergoing cardiac surgery before and after a protocol change.
  • The protocol limited antimicrobial prophylaxis to 48 hours post-sternal closure starting April 2013.
  • Risk factors for SSIs were identified, and SSI incidence was compared between pre- and post-protocol groups.

Main Results:

  • Delayed sternal closure and younger age were identified as risk factors for SSIs.
  • The mean duration of antimicrobial prophylaxis significantly decreased from 4.2 to 1.9 days post-protocol implementation (P < .0001).
  • No significant increase in SSI incidence was observed in the post-protocol group after adjusting for key risk factors (adjusted OR, 0.98; 95% CI, 0.32-3.00).

Conclusions:

  • A 48-hour antimicrobial prophylaxis duration following pediatric cardiac surgery is a safe practice and did not increase SSI rates at this institution.
  • Further research is recommended to validate these findings and explore strategies to mitigate SSIs in patients with delayed sternal closure.
Abstract

Keywords:
antibioticsantifungalsantiviral agentsinfectionwound infection

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