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J Thorac Cardiovasc Surg 2007;133:435-440
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Bloodstream infections after median sternotomy at a children’s hospital

Samir S. Shah, MDa,d,e,j,*, Jessica Kagen, BAa, Ebbing Lautenbach, MD, MPH, MSCEd,f,i,j, Warren B. Bilker, PhDd,i,j, Jennifer Matro, BAa, Troy E. Dominguez, MDh, Sarah Tabbutt, MD, PhDb,e,h, J. William Gaynor, MDc,g, Louis M. Bell, MDa,e

a Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pa
b Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pa
c Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pa
d Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa
e Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pa
f Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa
g Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa
h Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa
i Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pa
j Centers for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pa.

Read at the Annual Meeting of the Pediatric Academic Societies, San Francisco, Calif., April 29–May 2, 2006.

Received for publication June 30, 2006; revisions received July 29, 2006; accepted for publication September 6, 2006.

* Address for reprints: Samir S. Shah, MD, Division of Infectious Diseases, Room 1526, North Campus, The Children’s Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104. (Email: shahs{at}email.chop.edu).

OBJECTIVES: Postoperative bloodstream infections are a major source of morbidity and increased health care costs. In adults, mediastinitis has been described as a risk factor for bloodstream infections. The objectives of this retrospective cohort study were to determine the incidence and to identify risk factors for postoperative bloodstream infections among children after median sternotomy in an urban tertiary care children’s hospital.

METHODS: For this study, 192 patients were randomly selected from among all patients undergoing median sternotomy between January 1, 1995, and December 31, 2003.

RESULTS: Ninety-eight (51%) of the 192 eligible patients were male. The median patient age was 5.4 months (interquartile range: 1 day–41.5 years). Bloodstream infections occurred in 12 (6.3%; 95% confidence interval [CI]: 3.3%–10.7%) patients within the first 30 days after median sternotomy. Bloodstream infections developed a median of 11 days (range: 3–29 days) after median sternotomy. Gram-negative bacilli caused 6 (50%) of the 12 bloodstream infections. Specific causes of bloodstream infections included Pseudomonas aeruginosa (n = 3), coagulase-negative staphylococci (n = 3), Pseudomonas fluorescens-putida (n = 2), Staphylococcus aureus (n = 2), Serratia marcescens (n = 1), and Candida albicans (n = 1). Multivariable analysis revealed that the development of mediastinitis (odds ratio [OR], 28.16; 95% CI, 3.37–235.22) and the requirement for postoperative extracorporeal membrane oxygenation (OR, 12.52; 95% CI, 2.99–52.41) were associated with bloodstream infections after median sternotomy.

CONCLUSIONS: Postoperative bloodstream infections occurred in 6.3% of children undergoing median sternotomy. Postoperative mediastinitis and the requirement for extracorporeal membrane oxygenation were risk factors for bloodstream infections after median sternotomy. These findings warrant exploration in a larger, multicenter study.

Abbreviations and Acronyms BSI = bloodstream infection; CI = confidence interval; OR = odds ratio; SSI = surgical site infection




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