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Surgical Wound Infection, Cardiac Surgical Procedures, Pediatrics/Children, Review.
Background: Sternal wound infection is a severe complication of cardiac surgery in the pediatric population (0-18 years old) that can lead to increased morbidity, mortality, and prolonged hospitalization. Health professionals have the ability to perform some interventions during the pre, intra and post-surgery to correctly manage sternal wounds, with the goal of preventing infections. Objectives: To identify and discuss current best practice in the prevention, incidence, and treatment of infections of the cardiac surgery site in the pediatric population. Methods: Between February 20th 2021 and February 28th 2021 we consulted the PubMed database adopting full text, 20 years, Humans, English, Child aged 0 to 18 years as criteria. Twenty articles out of sixty-six were considered relevant to this study. These were divided into four themes. Results: All studies highlight the lack of standard guidelines for managing pediatric patients undergoing cardiac surgery. Some centers developed protocols for managing antibiotic prophylaxis supported by measurable interventions; others implemented infection surveillance systems involving families taking care of patients after hospital discharge. Discussions: the identification of healthcare-associated infections in the pediatric population after cardiac surgery is useful in all peri-operative phases. The limited and restricted literature connected to single centers, with relatively small sample sizes, the use of a single database. Conclusion: There is a lack of standard guidelines. The prevention of site infection ought to the goal of reducing surgical site infections. Building a network between the multidisciplinary staff and the pediatric patient’s family improves the infection surveillance system, reducing the incidence of infections.
2. Murray MT, Krishnamurthy G, Corda R, et al. Surgical site infections and bloodstream infections in infants after cardiac surgery. J Thorac Cardiovasc Surg. 2014a;148(1), 259-65. doi: 10.1016/j.jtcvs.2013.08.048.
3. Katayanagi T. Nasal methicillin-resistant S. aureus is a major risk for mediastinitis in pediatric cardiac surgery. Ann Thorac Cardiovasc Surg. 2015;21(1):37-44. doi: 10.5761/atcs.oa.14-00157.
4. Nelson-McMillan K, Hornik CP, He X, et al. Delayed Sternal Closure in Infant Heart Surgery-The Importance of Where and When: An Analysis of the STS Congenital Heart Surgery Database. Ann Thorac Surg. 2016;102(5):1565-1572. doi: 10.1016/j.athoracsur.2016.08.081.
5. Kansy A, Jacobs JP, Pastuszko A, et al. Major infection after pediatric cardiac surgery: external validation of risk estimation model. Ann Thorac Surg. 2012;94(6):2091-5. doi: 10.1016/j.athoracsur.2012.07.079.
6. Costello JM, Graham DA, Morrow DF, et al. Risk factors for surgical site infection after cardiac surgery in children. Ann Thorac Surg. 2010;89(6):1833-41; discussion 1841-2. doi: 10.1016/j.athoracsur.2009.08.081.
7. Sen AC, Morrow DF, Balachandran R, et al. Postoperative Infection in Developing World Congenital Heart Surgery Programs: Data From the International Quality Improvement Collaborative. Circ Cardiovasc Qual Outcomes. 2017;10(4). pii: e002935. doi: 10.1161/CIRCOUTCOMES.116.002935.
8. Lex DJ, Tóth R, Cserép Z, et al. Postoperative differences between colonization and infection after pediatric cardiac surgery-a propensity matched analysis. Journal of Cardiothoracic Surgery. 2013;8:166 http://www.cardiothoracicsurgery.org/content/8/1/166.
9. Turcotte RF, Brozovich A, Corda R, et al. Health care-associated infections in children after cardiac surgery. Pediatr Cardiol. 2014;35(8):1448-55. doi: 10.1007/s00246-014-0953-z.
10. Delgado-Corcoran C, Van Dorn CS, Pribble C, et al. Reducing pediatric sternal wound infections: a quality improvement project. Pediatric Critical Care Medicine. 2017;18(5), 461-68. doi: 10.1097/PCC.0000000000001135.
11. Sochet AA, Cartron AM, Nyhan A, et al. Surgical Site Infection After Pediatric Cardiothoracic Surgery. World J Pediatr Congenit Heart Surg. 2017;8(1):7-12. doi: 10.1177/2150135116674467.
12. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70:195-283.
13. Woodward CS, Son M, Calhoon J, Michalek J, Husain SA. Sternal wound infections in pediatric congenital cardiac surgery: a survey of incidence and preventative practice. Ann Thorac Surg. 2011;91(3):799-804. doi: 10.1016/j.athoracsur.2010.10.030.
14. Izquierdo-Blasco J, Campins-Martì M, Soler-Palacín P, et al. Impact of the implementation of an interdisciplinary infection control program to prevent surgical wound infection in pediatric heart surgery. Eur J Pediatric. 2015;174(7), 957-63. doi: 10.1007/s00431-015-2493-9.
15. Woodward CS, Son M, Taylor R, Husain SA. Prevention of sternal wound infection in pediatric cardiac surgery: a protocolized approach. World Journal for Pediatric and Congenital Heart Surgery. 2012;3(4), 463-69. doi: 10.1177/2150135112454145.
16. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. doi: 10.1186/2046-4053-4-1.
17. Silvetti S, Ranucci M, Isgrò G, Villa V, Costa E. Preoperative colonization in pediatric cardiac surgery and its impact on postoperative infections. Paediatr Anaesth. 2015;27(8):849-855. doi: 10.1111/pan.13169.
18. Staveski S, Abrajano C, Casazza M, et al. Silver-Impregnated dressings for sternotomy incision to prevent surgical site infections in children. Am J Crit Care. 2016;25(5), 402-08. doi: 10.4037/ajcc2016843.
19. Macher J, Gras Le Guen C, Chenouard A, et al. Preoperative Staphylococcus aureus Carriage and Risk of Surgical Site Infection After Cardiac Surgery in Children Younger than 1 year: A Pilot Cohort Study. Pediatr Cardiol. 2017;38:176–183 DOI 10.1007/s00246-016-1499-z.
20. Cannon M, Hersey D, Harrison S, et al. Improving surveillance and prevention of surgical site infection in pediatric cardiac surgery. Am J Crit Care. 2016;25(2), 30-7. doi: 10.4037/ajcc2016531.
21. Murray MT, Corda R, Turcotte R, et al. Implementing a standardized perioperative antibiotic prophylaxis protocol for neonates undergoing cardiac surgery. Ann Thorac Surg. 2014b;98(3), 927-33. doi: 10.1016/j.athoracsur.2014.04.090.
22. Bath S, Lines J, Loeffler AM, et al. Impact of standardization of antimicrobial prophylaxis duration in pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2016;152(4):1115-20. doi: 10.1016/j.jtcvs.2016.04.091.
23. Nayar V, Kennedy A, Pappas J, et al. Improving Cardiac Surgical Site Infection Reporting and Prevention By Using Registry Data for Case Ascertainment. Ann Thorac Surg. 2016;101(1):190-8; discussion 198-9. doi: 10.1016/j.athoracsur.2015.07.042.
24. Woodward C, Taylor R, Son M, et al. Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients. World J Pediatr Congenit Heart Surg. 2017;8(4):453-459. doi: 10.1177/2150135117713741.