Median sternotomy wound infections in children

Nine children (25 days to 15 years of age) with infectious complications of median sternotomy are described. Six infections were superficial and in three the sternum and/or mediastinum was involved. Risk factors predisposing to sternal wound infections in six patients were a pump bypass time in excess of 1 hour, excessive postoperative bleeding, low cardiac output for 24 hours or more postoperatively, reexploration for control of bleeding and inadequate antimicrobial prophylaxis. Eight infections were diagnosed at a mean of 15 days postoperatively (range, 5 to 30 days), and chronic sternal osteomyelitis was diagnosed 4 years after operation in one patient. Stability of the sternum was a critical feature differentiating between superficial and deep wound infections. Staphylococcus aureus or Staphylococcus epidermidis was isolated from the wound and/or blood of five patients, and Gram-negative enteric rods were isolated in three patients (two with sternal osteomyelitis and mediastinitis). Local debridement was sufficient for adequate drainage in four patients, but reexploration for debridement and rewiring of the sternum or drainage of mediastinal contents was required in four. All patients improved initially following drainage and administration of parenteral antibiotics for a mean of 12 (superficial infection) or 28 (deep infection) days. Two patients developed chronic sternal osteomyelitis, and one died due to rupture of a mycotic aneurysm of the aorta 7 years postoperatively.