Sternal wound and mediastinal infections in infants with congenital heart disease

The objective was to describe the epidemiologic, clinical, bacteriologic an d therapeutic features of seven infants who developed sternal wound and med iastinal infections following palliation and/or repair procedures for conge nital heart disease. A retrospective chart review was used. All infants wit h sternal wound and mediastinal infections were < 30 days of age at the ini tial operative procedure. Six of the infants had hypoplastic left heart syn drome, and one had complete transposition. Two infants required delayed clo sure of their chest wound. Three infants had superficial sternal infections and presented at a mean of 12 days postoperatively. Four infants had infec tion of the deep mediastinal structures: they were all asymptomatic and had purulent collections in their mediastinum at their second palliative opera tion, which was performed at a mean of 120 days after the initial surgery. Staphylococcus aureus, or coagulase-negative Staphylococcus, was isolated f rom the wound and/or blood of six infants. All infants with mediastinal inf ections were managed with operative debridement. Infants with superficial i nfections underwent local debridement. All infants received long-term intra venous 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.