Management of pediatric cardiac surgery wound: a literature review

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Angela Prendin
Benedicta Tabacco
Paola Claudia Fazio
Ilaria de Barbieri


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.


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1. Harder EE, Gaies MG, Yu S, et al. Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J Thorac Cardiovasc Surg. 2013;146(2), 326-33. doi: 10.1016/j.jtcvs.2012.09.062.
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
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.