Infection

Surgical site infection (superficial/deep/organ):

• Prevalence 5-10%
• Within 10-14 days post surgery
• Most common: Staphylococcus aureus
• Risk factors: neonate, HLHS, hospitalization prior surgery, TPN, emergency procedures, long CPB

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Blood stream infection:

• Prevalence 5-10%
• Within 10-14 days post surgery
• Most common: gram negative organism (Pseudomonas, Enterobacter)
• Risk factors: surgical complexity, open sternum, low body weight, longer duration of central line, prolonged ICU stay

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Pulmonary infection:

• Prevalence 10%
• Risk factors: prolonged mechanical ventilation, surgical complexity, low cardiac output syndrome, failed extubation

Current recommendation for antimicrobial prophylaxis in cardiac surgery: cefazolin up to 72 hrs (prolonged use may increase antimicrobial resistance). In the setting of either a presumed or known Staphylococcal colonisation, the hospital presence of a high incidence of MRSA, patients susceptible to colonisation, or an operation for a patient having prosthetic valve or vascular graft insertion, it would be reasonable to combine the beta-lactam with a glycopeptide (vancomycin) for prophylaxis.

Special considerations in immunodeficient syndromes (DiGeorge Syndrome, postoperative – see chylothorax).

See also sepsis and fever.

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References:

[1] Am J Infect Control 2010 Nov;38(9):706-710: Sohn et al: Risk factors and risk adjustement for surgical site infections in pediatric cardiothoracic surgery patients

[2] Pediatr Cardiol 2010 May;31(4): 483-9: Abou Elella et al: Impact of bloodstream infection on the outcome of children undergoing congenital heart surgery

[3] Am J Health Syst Pharm 2008 Nov 1;65(21): 2008, 2010: Survey of congenital heart surgeons’ preferences for antimicrobial prophylaxis for pediatric cardiac surgery patients

[4] Ann Thorac Surg 2007 Apr; 83(4): 1569-76: Engelman et al: The Society of thoracic surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, Part II: Antibiotic Choice

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