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

John T Kennedy1,2, Olivia DiLeonardo3,4, Christopher G Hurtado1

  • 1124506University of Central Florida College of Medicine, Orlando, FL, USA.

World Journal for Pediatric & Congenital Heart Surgery
|August 14, 2020
PubMed

Insights

Multidrug antibiotic prophylaxis after delayed sternal closure in pediatric cardiac surgery significantly reduces surgical site and bloodstream infections compared to single-drug approaches. This finding aids in standardizing infection prevention strategies.

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.

Keywords:
antibioticscongenital heart surgeryinfectionintensive caremediastinal infectionwound infection

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