Bloodstream Infections Increased After Delayed Sternal Closure: Cause or Coincidence

• Published in: The Annals of thoracic surgery Vol. 91; no. 3; pp. 793 - 797
• Main Authors: Das, Srikant, MD, Rubio, Agustin, MD, Simsic, Janet M., MD, Kirshbom, Paul M., MD, Kogon, Brian, MD, Kanter, Kirk R., MD, Maher, Kevin, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacteremia - epidemiology; Bacteremia - etiology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Follow-Up Studies; Georgia - epidemiology; Hospital Mortality - trends; Human bacterial diseases; Humans; Hypoplastic Left Heart Syndrome - surgery; Incidence; Infant, Newborn; Infectious diseases; Medical sciences; Norwood Procedures - methods; Pneumology; Retrospective Studies; Risk Factors; Sternotomy; Surgery; Surgical Wound Dehiscence - complications; Surgical Wound Dehiscence - epidemiology; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Georgia; 21; Infection; Closure; Sternum; Bacteriosis; Anesthesia; Circulatory system; Cardiology; Bacteremia; Delay
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2010.09.055

Background Infants who undergo major cardiac operations are at risk for developing bloodstream infections which contribute to the morbidity, mortality, and cost of treatment. Determining what factors are associated with this increased risk of infection may aid in prevention. We sought to evaluate the practice of delayed sternal closure after neonatal cardiac surgery to determine its role as a risk factor for postoperative bloodstream infection. Methods We reviewed 110 consecutive patients with hypoplastic left heart syndrome after stage 1 Norwood procedure at Children's Healthcare of Atlanta. The rates of bloodstream infections were determined and risks analyzed with regard to postoperative status of sternal closure; primary versus delayed. Results Delayed sternal closure was utilized in 67 of 110 patients (61%), while 43 patients had primary sternal closure in the operating room. Overall rate of bloodstream infection was 22% (24 of 110), with 83% (20 of 24) of infections occurring in the delayed closure group. Among infants with delayed closure, 30% developed bloodstream infection, as compared with 9% of patients with primary closure ( p = 0.017). Patients with delayed closure had a fourfold increased risk (odds ratio 3.9, p = 0.03) of developing bloodstream infection in-hospital. Predominant organisms were coagulase negative Staphylococcus species; there was one case of mediastinitis. Conclusions Delayed sternal closure is associated with an increased likelihood of bloodstream infection and should be recognized as a risk factor after neonatal cardiac operations.