Copeland Hannah, Newcombe Jennifer, Yamin Feras, Bhajri Khaled, Mille Vanessa Ayer, Hasaniya Nahidh, Bailey Leonard, Razzouk Anees J
1 Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
2 Children's Hospital, Loma Linda University, Loma Linda, CA, USA.
World J Pediatr Congenit Heart Surg. 2018 Jul;9(4):440-445. doi: 10.1177/2150135118772494.
Sternal wound infections after pediatric cardiac surgery are uncommon but can be morbid.
We describe an institutional protocol for complicated sternal wounds utilizing hyperbaric oxygen therapy (HBO) and negative pressure wound therapy (NPWT).
A retrospective chart review (2001-2013) of 4,028 pediatric cardiac operations in 3,264 patients less than 18 years of age.
Fifty-three patients (1.62%; 53/3,264) were diagnosed with clinical sternal wound infections. There were 27 (50.9%) males and 26 (49.1%) females. Thirty-seven (69.8%) patients received antibiotics and/or debridement; sixteen (30.2%) patients had more complicated infections requiring NPWT and/or HBO therapy. The time to heal for wounds treated with HBO and HBO + NPWT was a mean of 43.75 (±24.27) days (range: 21-98 days; median: 35 days). Among all infected patients, the time from diagnosis of the infection to resolution of the infection for all survivors was 7 to 98 days (mean: 26.41 days; median: 21 days). Forty-eight (90.6%) patients completely healed their wounds, and 45 (84.9%) patients are currently alive. Thirty-eight patients had a cyanotic cardiac diagnosis and 15 had an acyanotic cardiac diagnosis. The most common bacteria isolated from the blood or wound cultures was Staphylococcus aureus. Six of 53 patients died. Causes of death are as follows: three from respiratory failure, one from sepsis, one from hypoxic ischemic encephalopathy, and one from exsanguination leading to cardiac arrest Conclusions: Complicated sternal wound infections after pediatric cardiac surgery refractory to antibiotic therapy and/or debridement can be successfully treated with NPWT and/or HBO therapy.
小儿心脏手术后胸骨伤口感染并不常见，但可能会导致严重后果。
我们描述了一种针对复杂胸骨伤口的机构方案，该方案采用高压氧治疗（HBO）和负压伤口治疗（NPWT）。
对3264例18岁以下患者的4028例小儿心脏手术进行回顾性病历审查（2001年至2013年）。
53例患者（1.62%；53/3264）被诊断为临床胸骨伤口感染。其中男性27例（50.9%），女性26例（49.1%）。37例（69.8%）患者接受了抗生素治疗和/或清创术；16例（30.2%）患者感染较为复杂，需要进行NPWT和/或HBO治疗。接受HBO和HBO+NPWT治疗的伤口愈合时间平均为43.75（±24.27）天（范围：21至98天；中位数：35天）。在所有感染患者中，所有幸存者从感染诊断到感染消退的时间为7至98天（平均：26.41天；中位数：21天）。48例（90.6%）患者伤口完全愈合，45例（84.9%）患者目前仍存活。38例患者患有青紫型心脏病诊断，15例患者患有非青紫型心脏病诊断。从血液或伤口培养物中分离出的最常见细菌是金黄色葡萄球菌。53例患者中有6例死亡。死亡原因如下：3例死于呼吸衰竭，1例死于败血症，1例死于缺氧缺血性脑病，1例死于失血导致的心脏骤停。结论：小儿心脏手术后对抗生素治疗和/或清创术难治的复杂胸骨伤口感染可以通过NPWT和/或HBO治疗成功治愈。
