A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children

Area of Science:

• Pediatric Cardiac Surgery
• Infectious Disease Prevention
• Clinical Pharmacy

Background:

• Antibiotic prophylaxis following delayed sternal closure in pediatric cardiac surgery lacks standardization.
• Current practices vary, necessitating a review of existing evidence.

Purpose of the Study:

• To systematically review antibiotic prophylaxis regimens used after delayed sternal closure in pediatric cardiac surgery.
• To analyze the impact of different regimens on postoperative infection rates.

Main Methods:

• Systematic literature review of studies published between 1990 and 2019.
• Collected data on patient characteristics, antimicrobial prophylaxis, and infection incidence.
• Analyzed 28 studies involving over 3,000 patients and 36 distinct regimens.

Main Results:

• The overall incidence of surgical site infection was 7.5% and bloodstream infection was 7.4%.
• Multidrug regimens showed significantly lower surgical site infection (4.6% vs. 20%) and bloodstream infection (6.0% vs. 50%) rates in the 2010s compared to single-drug regimens.
• Cefazolin-only was the most frequent single-drug regimen.

Conclusions:

• Multidrug antibiotic prophylaxis is associated with improved outcomes in pediatric cardiac surgery patients with delayed sternal closure.
• Findings support the development of standardized, multidrug-based prophylaxis protocols.
• Further research and clinical trials can be informed by this evidence to optimize infection control.