Antibiotic Management for Delayed Sternal Closure Following Pediatric Cardiac Surgery: A Systematic Review of Recent Literature

被引:9
作者
Silvetti, Simona [1 ]
Landoni, Giovanni [2 ]
Castagnola, Elio [3 ]
Nuri, Halkawt [4 ]
Pome, Giuseppe [4 ]
Moscatelli, Andrea [1 ]
机构
[1] IRCCS Ist Giannina Gaslini, Neonatal & Pediat Intens Care Unit, Dept Surg & Crit Care, Genoa, Italy
[2] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Dept Anesthesia & Intens Care, Milan, Italy
[3] IRCCS Ist Giannina Gaslini, Infect Dis Unit, Dept Pediat, Genoa, Italy
[4] IRCCS Ist Giannina Gaslini, Cardiac Surg Unit, Dept Surg & Crit Care, Genoa, Italy
关键词
antibiotic; cardiac surgery; congenital heart diseases; delayed sternal closure; anesthesia; intensive care; SURGICAL SITE INFECTIONS; ANTIMICROBIAL PROPHYLAXIS; HEART-SURGERY; RISK-FACTORS; PREVENTION; OPERATIONS; OUTCOMES; IMPACT;
D O I
10.1053/j.jvca.2019.07.134
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Delayed sternal closure after pediatric cardiac surgery is a management option for the treatment of patients with severely impaired heart function. The optimal antimicrobial treatment strategy for this condition is unknown. The aim of this systematic review was to evaluate the current antibiotic administration attitudes in pediatric cardiac surgery patients needing an open chest in terms of infection with a focus on surgical site infection rate. The authors performed a systematic review and meta-analysis of all articles, which described the antibiotic administration strategy and surgical site infection rate in pediatric patients with an open chest after cardiac surgery. The authors performed a subgroup analysis on "standard" versus "non-standard" (defined as any antimicrobial drugs different from the adult guidelines recommendations) therapy for one-proportion meta-analysis with a random effect model. The authors identified 12 studies published from January 1, 2000 to July 1, 2019 including a total of 2,203 patients requiring an open chest after cardiac surgery, 350 of whom (15.9%) developed infections and 182 (8.3%) developed a surgical site infection. The surgical site infection rate in patients with "non-standard" strategy was higher than in patients with "standard" strategy: 8.8% (140 reported infections/1,582 patients) versus 6.8% (42 reported infections/621 patients), p = 0.001. The "standard" antibiotic management proposed by guidelines for adult cardiac surgery patients could be used an acceptable strategy to treat pediatric patients with an open chest after cardiac surgery. (C) 2019 Elsevier Inc. All rights reserved.
引用
收藏
页码:1333 / 1340
页数:8
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