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Delayed sternal closure increases the risk of mid-sternum infections in children following cardiac surgery

To correct life-threatening, complex congenital heart disease in children, most median sternotomies (cracking open of the rib cage for open heart surgery) are performed within the first few weeks of life. Infection of the mid-sternum between the lungs (mediastinitis) strikes 1.4 percent of children who undergo this procedure and 3 percent of children who undergo the procedure for heart and lung transplant. Delayed sternal closure appeared to elevate the risk of sternal infection according to a study supported in part by the Agency for Healthcare Research and quality (HS10399).

Researchers at the University of Pennsylvania Center for Education and Research on Therapeutics used hospital records to identify 43 children who developed mediastinitis at a children's hospital from 1995 through 2003. The incidence of mediastinitis was 1.4 percent. Median time to onset of infection after surgery was 11 days. Although Gram-positive organisms were the most common cause of infection (67 percent of cases), Gram-negative organisms accounted for one-third (30 percent) of all cases.

After considering several factors such as duration of antibiotics before infection, chest tube at the time of infection, and duration of preoperative hospitalization, delayed sternal closure substantially increased by 9-fold the risk of infection with Gram-negative bacteria (for example, Escherichia coli and Pseudomonas aeruginosa). More than one-half (53 percent) of patients with mediastinitis had concurrent bloodstream infection with the same bacteria.

See "Postoperative mediastinitis in children," by Caroline B. Long, M.D., Samir S. Shah, M.D., Ebbing Lautenbach, M.D., M.P.H., M.S.C.E., and others, in the April 2005 Pediatric Infectious Disease Journal 24(4), pp. 315-319.

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