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Antibiotic Prophylaxis for Open Chest Management After Pediatric Cardiac Surgery
Takeshi Hatachi1, Toshiki Sofue1, Yukie Ito1
1Department of Intensive Care Medicine, Osaka Women's and Children's Hospital 840 Murodocho, Izumi, Osaka, Japan.
Insights
Broad-spectrum antibiotic prophylaxis, specifically vancomycin + meropenem, reduced bloodstream and surgical site infections in pediatric cardiac surgery patients undergoing open chest management. Further research is needed to confirm these findings for routine use.
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.
Objectives:
Although open chest management optimizes hemodynamics after cardiac surgery, it increases postoperative infections and leads to increased mortality. Despite the importance of antibiotic prophylaxis during open chest management, no specific recommendations exist. We aimed to compare the occurrence rates of bloodstream infection and surgical site infection between the different prophylactic antibiotic regimens for open chest management after pediatric cardiac surgery.
Design:
Retrospective, single-center, observational study.
Setting:
PICU at a tertiary children's hospital.
Patients:
Consecutive patients younger than or equal to 18 years old with open chest management after cardiac surgery followed by delayed sternal closure, between January 2012 and June 2018.
Interventions:
None.
Measurements And Main Results:
We compared the composite occurrence rate of postoperative bloodstream infection and surgical site infection within 30 days after cardiac surgery between three prophylactic antibiotic regimens: 1) cefazolin, 2) cefazolin + vancomycin, and 3) vancomycin + meropenem. In 63 pediatric cardiac surgeries with open chest management, 17 bloodstream infections, and 12 surgical site infections were identified postoperatively. The composite occurrence rates of bloodstream infection and surgical site infection were 10 of 15 (67%), 10 of 19 (53%), and nine of 29 (31%) in the cefazolin, cefazolin + vancomycin, and vancomycin + meropenem regimens, respectively (p = 0.07). After adjusting for age, open chest management duration, extracorporeal membrane oxygenation use, and nasal methicillin-resistant Staphylococcus aureus colonization in multivariable analysis, there was no significant difference between the cefazolin and the cefazolin + vancomycin regimens (p = 0.19), while the vancomycin + meropenem regimen had a lower occurrence rate of bloodstream infection and surgical site infection than the cefazolin regimen (odds ratio, 0.0885; 95% CI, 0.0176-0.446; p = 0.003).
Conclusions:
In this study, a lower occurrence rate of postoperative bloodstream infection and surgical site infection was observed among patients with broad-spectrum antibiotic regimen after pediatric cardiac surgery with open chest management. Further studies, ideally randomized controlled studies investigating the efficacy of broad-spectrum antibiotics and their complications, are warranted before routine implementation of broad-spectrum prophylactic antibiotic regimen.
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