Risk factors for sternal wound and other infections in pediatric cardiac surgery patients

Background. This study was undertaken to determine the incidence, pathogens and risk factors associated with development of sternal wound and other in fections in children undergoing cardiac surgery. Methods. Retrospective chart review was performed for all cardiac surgeries performed on children <18 years of age at Upstate Medical University at Sy racuse between January, 1996, and June, 1998. For evaluation of risk factor s for sternal wound infection, only patients undergoing sternotomy are incl uded in the analysis: those with infection are compared with those without for preoperative, intraoperative and postoperative risk factors. Results. Sternal wound infection developed in 10 of 202 (5%) children after median sternotomy. Superficial sternal wound infection developed in 6 (3%) children, and 4 (2%) had deep infection. Children with sternal wound infec tion had lower age, higher American Society of Anesthesiologist score, long er preoperative stay, longer period of ventilation and inotropic support, l onger intensive care unit and total postoperative hospital stays and increa sed leukocyte band cell counts preoperatively and on Postoperative Day 1 th an those without sternal infection. Causative agents for sternal wound infe ction were Staphylococcus aureus (6), Pseudomonas aeruginosa (1) and Haemop hilus influenzae non-type b (1). In addition 32 bacterial infections occurr ed at nonsurgical sites after 28 procedures. Infections included pneumonia, urinary tract infection and bacteremia. Longer bypass time and longer oper ation time were two additional risk factors for non-wound infection. Conclusion. Infections continue to be a significant cause of morbidity in c ardiac surgery patients. Knowledge of risk factors for infection could be u seful in preventive and treatment strategies for these high-risk groups.