Perioperative antibiotic prophylaxis in paediatric cardiac surgery

Abstract

R ISK OF INFECTION, AND ANTIBIOTIC PROPHYLAXIS, are topics that have been debated for decades by those involved in the care of children undergoing cardiac surgery. In this review we attempt to analyse what is known and what has been postulated about this subject. Suggestions regarding the best strategies for treatment have been formulated, based on published reports, as well as current practices worldwide. The burden of infection of the site of cardiac surgery Cardiac surgery is clean surgery, and should be associated with an incidence of infection less than 5%. Recent studies in adults have demonstrated an incidence of 2 to 6.4% for superficial infections of sternal wounds, 1-3 and an incidence of deep infections or mediastinitis that ranges from 0.77 to 3.3%. 1-5 The National Cardiac Surgical Database of the Society of Thoracic Surgeons revealed an incidence of deep sternal infections of 0.4% in 2002. Lu et al. 6 demonstrated a significantly higher mortality in patients with infected sternal wounds compared to those without such infection during a 4-year follow-up period after coronary arterial bypass grafting. Postoperative mediastinitis is associated with a mortality of up to 16%. 7 This complication is

Nosocomial infections in infants and children after cardiac surgery

“…15 The type of antibiotic prophylaxis chosen in this study was based on the past culture reports of the prevalent microbial flora among patients who developed NI and may not conform to standard published guidelines. 4 From the results of our study, it appears that the most important steps towards reducing NI rates are reducing ICU stay and duration of intubation. The other important steps would be to identify beforehand the subset of patients with risk factors for NI and enforce particularly stringent infection control guidelines.…”

“…Children undergoing OHS are at high risk of developing NI because of an immature immunologic system, long duration of surgery, institution of greater degree of hypothermia, delayed sternal closure following complex reconstructions especially in neonates, need for extracorporeal life support and delayed return to normal feeding patterns, necessitating prolonged central venous access for parentral nutrition. 4 This study provides information on the epidemiology of NIs in our unit which is representative of most units in a developing nation. The NI rate was 49%, which was comparable with 48.1% 5 in a study on NIs after Pre-operative congestive heart failure, pre-operative balloon atrial septostomy during the same hospital admission, hypothermia (nasopharyngeal temperature < 30 o C) during surgery, reintubation, tracheostomy and blood transfusion emerged to be other significant risk factors for NI (Table 6).…”

“…Antibiotic prophylaxis was not according to standard published guidelines. 4 Possibility of colonization was not eliminated. The study was performed in a single centre, and therefore its results cannot be generalized to all cardiac surgical ICUs.…”

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…Selection of antimicrobial prophylactic agents mirrors that in adult guidelines, with the agents of choice being first-and second-generation cephalosporins, reserving the use of vancomycin for patients with documented b-lactam allergies. 19,20 While the use of a penicillin with a b-lactamase inhibitor in combination with cefazolin or vancomycin and gentamicin has also been studied in pediatric patients, the number of patients included in these evaluations remains small. [20][21][22][23] As with adults, there is little evidence supporting the use of vancomycin, alone or in combination with other antimicrobials, for routine perioperative antimicrobial prophylaxis in institutions that have a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA).…”

Efficacy of limited cefuroxime prophylaxis in pediatric patients after cardiovascular surgery

“…However, the use of extended antimicrobial prophylaxis in children after cardiothoracic surgery remains current practice among some surgeons. (6)(7)(8) The exact reason is unclear but may reflect ongoing practices taught during pediatric cardiovascular surgical fellowship training and individual surgeon practice variation.…”