Document Detail


Bloodstream infections increased after delayed sternal closure: cause or coincidence.
MedLine Citation:
PMID:  21353000     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Srikant Das; Agustin Rubio; Janet M Simsic; Paul M Kirshbom; Brian Kogon; Kirk R Kanter; Kevin Maher
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  91     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-28     Completed Date:  2011-05-05     Revised Date:  2012-01-30    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  793-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Pediatric Cardiology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA.
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MeSH Terms
Descriptor/Qualifier:
Bacteremia / epidemiology,  etiology*
Follow-Up Studies
Georgia / epidemiology
Hospital Mortality / trends
Humans
Hypoplastic Left Heart Syndrome / surgery*
Incidence
Infant, Newborn
Norwood Procedures / methods*
Retrospective Studies
Risk Factors
Sternotomy*
Surgical Wound Dehiscence / complications*,  epidemiology
Surgical Wound Infection / epidemiology,  etiology*
Comments/Corrections
Comment In:
Ann Thorac Surg. 2012 Jan;93(1):360; author reply 360-1   [PMID:  22186477 ]
Ann Thorac Surg. 2011 Mar;91(3):797-8   [PMID:  21353001 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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