Antibiotic Prophylaxis for Open Chest Management After Pediatric Cardiac Surgery

Area of Science:

• Pediatric Cardiac Surgery
• Infectious Disease Management
• Antibiotic Prophylaxis

Background:

• Open chest management in pediatric cardiac surgery optimizes hemodynamics but increases infection risk.
• Current antibiotic prophylaxis guidelines for this specific scenario are lacking.
• Postoperative infections are associated with increased mortality.

Purpose of the Study:

• To compare infection rates between different prophylactic antibiotic regimens in pediatric cardiac surgery with open chest management.
• To evaluate the efficacy of cefazolin, cefazolin + vancomycin, and vancomycin + meropenem.
• To identify optimal antibiotic strategies to reduce postoperative infections.

Main Methods:

• Retrospective, single-center observational study of pediatric patients (≤18 years) undergoing open chest management after cardiac surgery.
• Comparison of bloodstream infection (BSI) and surgical site infection (SSI) rates within 30 days.
• Analysis of three antibiotic regimens: cefazolin, cefazolin + vancomycin, vancomycin + meropenem.

Main Results:

• The vancomycin + meropenem regimen showed a significantly lower composite occurrence rate of BSI and SSI (31%) compared to cefazolin (67%) after multivariable adjustment (OR, 0.0885; p=0.003).
• No significant difference was found between cefazolin and cefazolin + vancomycin regimens (p=0.19).
• Adjusted analysis considered age, duration of open chest management, ECMO use, and MRSA colonization.

Conclusions:

• Broad-spectrum antibiotic prophylaxis (vancomycin + meropenem) was associated with reduced postoperative infection rates in this pediatric cardiac surgery cohort.
• Further randomized controlled studies are necessary to validate these findings and assess potential complications before widespread adoption.
• Evidence suggests a potential benefit of broader antibiotic coverage in high-risk surgical populations.