Antibiotic Management for Delayed Sternal Closure Following Pediatric Cardiac Surgery: A Systematic Review of Recent...

Area of Science:

• Pediatric Cardiac Surgery
• Infectious Disease Management
• Antimicrobial Stewardship

Background:

• Delayed sternal closure is a strategy for pediatric cardiac surgery patients with severe heart dysfunction.
• Optimal antimicrobial treatment for this patient group remains undetermined.
• Understanding infection rates, particularly surgical site infections (SSIs), is crucial.

Purpose of the Study:

• To systematically review and meta-analyze antibiotic administration strategies in pediatric cardiac surgery patients with open chests.
• To evaluate the impact of these strategies on infection and surgical site infection (SSI) rates.
• To compare "standard" (adult guideline-based) versus "non-standard" antibiotic therapies.

Main Methods:

• Systematic review and meta-analysis of studies from 2000-2019.
• Inclusion of 12 studies with 2,203 pediatric patients requiring open chest after cardiac surgery.
• Subgroup analysis comparing "standard" and "non-standard" antibiotic regimens using a random effect model.

Main Results:

• Overall infection rate was 15.9% (350/2,203), with an SSI rate of 8.3% (182/2,203).
• Patients receiving "non-standard" antibiotic therapy had a higher SSI rate (8.8%) compared to those on "standard" therapy (6.8%).
• The difference in SSI rates between "standard" and "non-standard" groups was statistically significant (p=0.001).

Conclusions:

• The "standard" antibiotic management recommended for adult cardiac surgery patients appears to be an acceptable strategy for pediatric patients.
• Adopting adult guidelines may help optimize antimicrobial treatment and potentially reduce SSI rates in this vulnerable pediatric population.
• Further research may refine antibiotic protocols for delayed sternal closure in pediatric cardiac surgery.