Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-18T10:37:44.900Z Has data issue: false hasContentIssue false
  • English
  • Français

Sternal wound and mediastinal infections in infants with congenital heart disease

Published online by Cambridge University Press:  19 August 2008

Barbara Kearns ,
Camille Sabella ,
Roger B. B. Mee ,
Douglas S. Moodie  and
Johanna Goldfarb
Barbara Kearns
Affiliation:
Division of Pediatrics, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA
Camille Sabella*
Affiliation:
Division of Pediatrics, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA Section of Pediatric Infectious Diseases, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA
Roger B. B. Mee
Affiliation:
Division of Pediatrics, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA Department of Pediatric and Congenital Heart Surgery, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA
Douglas S. Moodie
Affiliation:
Division of Pediatrics, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA Department of Pediatric Cardiology, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA
Johanna Goldfarb
Affiliation:
Division of Pediatrics, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA Section of Pediatric Infectious Diseases, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA
*
Camille Sabella, MD, Division of Pediatrics, Desk A-120, The Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Tel: 216 445 6862; Fax: 216 445 7792; E-mail: sabellc@cesmtp.ccf.org
Get access Rights & Permissions [Opens in a new window]

Abstract

The objective was to describe the epidemiologic, clinical, bacteriologic and therapeutic features of seven infants who developed sternal wound and mediastinal infections following palliation and/or repair procedures for congenital heart disease. A retrospective chart review was used. All infants with sternal wound and mediastinal infections were < 30 days of age at the initial operative procedure. Six of the infants had hypoplastic left heart syndrome, and one had complete transposition. Two infants required delayed closure of their chest wound. Three infants had superficial sternal infections and presented at a mean of 12 days postoperatively. Four infants had infection of the deep mediastinal structures: they were all asymptomatic and had purulent collections in their mediastinum at their second palliative operation, which was performed at a mean of 120 days after the initial surgery. Staphylococcus aureus, or coagulase-negative Staphylococcus, was isolated from the wound and/or blood of six infants. All infants with mediastinal infections were managed with operative debridement. Infants with superficial infections underwent local debridement. All infants received long-term intravenous antibiotics. Mediastinal infections in infants undergoing palliative staged procedures for congenital heart lesions may be chronic and indolent, resulting in delayed repair of congenital heart lesions.

Keywords

Mediastinitiscongenital heart diseasesternal wound infection
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 3 , May 1999 , pp. 280 - 284
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Culliford, AT, Cunnigham, JN Jr, Zeff, RH, Isom, OWTeiko, P, Spenser, FC. Sternal and costochondral infections following open-heart surgery: A review of 2,594 cases. J Thorac Cardiovasc Surg 1976; 72: 714–726.CrossRefGoogle Scholar
2.Edwards, MS, Baker, CJ. Median sternotomy wound infections in children. Pediatr Infect Dis 1983; 2: 105–109.CrossRefGoogle ScholarPubMed
3.Fraser, CD Jr, Mee, RBB. Modified Norwood procedure for hypoplastic left heart syndrome. Ann Thorac Surg 1995; 60: S546–549.CrossRefGoogle ScholarPubMed
4.Mee, RBB. The arterial switch operation. In Stark, J, Pacifico, AP (eds). Surgery for Congenital Heart Defects, 2nd edn.W B. Saunders, Philadelphia, 1994, pp 483–500.Google Scholar
5.Stiegel, RM, Beasley, ME, Sink, JD, Hester, TR, Guyton, RA, Perrella, AM, Williams, WH. Management of postoperative mediastinitis in infants and children by muscle flap rotation. Ann Thorac Surg 1988; 46: 45–46.CrossRefGoogle ScholarPubMed
6.Pollock, EMM, Ford-Jones, EL, Rebeyka, I, Mindorff, CM, Bohn, DJ, Edmonds, JF, Lightfoot, NE, Coles, J, Williams, WG, Trusler, GA, Barker, GA. Early nosocomial infections in pediatric cardiovascular surgery patients. Crit Care Med 1990; 18: 378.CrossRefGoogle ScholarPubMed
7.Tabbutt, S, Duncan, BWMcLaughlin, D, Wessel, DL, Jonas, RA, Laussen, PC. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg 1997; 113: 886–893.CrossRefGoogle Scholar
8.Hall, SL. Coagulase-negative staphylococcal infections in neonates. Pediatr Infect Dis J 1991; 10: 57–67.CrossRefGoogle ScholarPubMed