Risk Factors for Pediatric Mediastinitis after Cardiac Surgery: Investigation of a Case Cluster

Risk Factors for Pediatric Mediastinitis after Cardiac Surgery: Investigation of a Case Cluster Pages E84-E85 E. Teszner*, S. Tabbutt, S. Shah, T. Zaoutis, K. St. John, L. Bell, T. Spray, S. Coffin Close Close preview | Purchase PDF (70 K) | Related articles | Related reference work articles AbstractAbstract Abstract BACKGROUND: Mediastinitis is a rare but serious complication of cardiothoracic surgery. Active surveillance of children undergoing cardiac surgery with median sternotomy revealed a cluster of five cases of deep sternal wound infection or mediastinitis (DSW-M) within a 2-month period. OBJECTIVES: To identify risk factors for DSW-M in children undergoing median sternotomy. METHODS: Cases of DSW-M were identified by active surveillance of all cardiac surgical patients at the Childrenʹs Hospital of Philadelphia. Four control patients were randomly selected from all patients undergoing median sternotomy who survived for >30 days after surgery. Controls for each case were matched by month of surgery and age group. Data was collected from review of microbiology laboratory reports and medical records. RESULTS: Bacterial cultures revealed three infections due to Staphylococcus aureus, and one due to vancomycin-resistant Enterococcus. The fifth patientʹs infection was polymicrobial; cultures from this patient grew Serratia marcescens and Pseudomonas aeruginosa. DSW-M was more common in children with complex cardiac physiology. Children with two ventricles with a normal aortic arch at the time of surgical procedure had a lower risk of developing DSW-M (p=0.02). Factors associated with an increased risk of deep wound infection included prolonged bypass time (p=0.004), need for re-operation within 48 hours (p=0.04), and inappropriate timing of peri-operative antibiotic prophylaxis (p=0.05). Factors not associated with DSW-M included presence of intracardiac pacemaker wires, right atrial catheters, or the use of prosthetic material. In addition, DSW-M was not associated with a specific surgeon, anesthetist, perfusionist, or nurse. CONCLUSION: DSW-M occurs more commonly following surgical intervention for severe congenital heart anomalies. Most identified risk factors for DSW-M were not modifiable. However, improved timing of peri-operative antibiotic prophylaxis might reduce the incidence of DSW-M in these susceptible patients.