Department of Intensive Care Medicine, Osaka Women's and Children's Hospital 840 Murodocho, Izumi, Osaka, Japan.
Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital 840 Murodocho, Izumi, Osaka, Japan.
Pediatr Crit Care Med. 2019 Sep;20(9):801-808. doi: 10.1097/PCC.0000000000001995.
Although open chest management optimizes hemodynamics after cardiac surgery, it increases postoperative infections and leads to increased mortality. Despite the importance of antibiotic prophylaxis during open chest management, no specific recommendations exist. We aimed to compare the occurrence rates of bloodstream infection and surgical site infection between the different prophylactic antibiotic regimens for open chest management after pediatric cardiac surgery.
Retrospective, single-center, observational study.
PICU at a tertiary children's hospital.
Consecutive patients younger than or equal to 18 years old with open chest management after cardiac surgery followed by delayed sternal closure, between January 2012 and June 2018.
None.
We compared the composite occurrence rate of postoperative bloodstream infection and surgical site infection within 30 days after cardiac surgery between three prophylactic antibiotic regimens: 1) cefazolin, 2) cefazolin + vancomycin, and 3) vancomycin + meropenem. In 63 pediatric cardiac surgeries with open chest management, 17 bloodstream infections, and 12 surgical site infections were identified postoperatively. The composite occurrence rates of bloodstream infection and surgical site infection were 10 of 15 (67%), 10 of 19 (53%), and nine of 29 (31%) in the cefazolin, cefazolin + vancomycin, and vancomycin + meropenem regimens, respectively (p = 0.07). After adjusting for age, open chest management duration, extracorporeal membrane oxygenation use, and nasal methicillin-resistant Staphylococcus aureus colonization in multivariable analysis, there was no significant difference between the cefazolin and the cefazolin + vancomycin regimens (p = 0.19), while the vancomycin + meropenem regimen had a lower occurrence rate of bloodstream infection and surgical site infection than the cefazolin regimen (odds ratio, 0.0885; 95% CI, 0.0176-0.446; p = 0.003).
In this study, a lower occurrence rate of postoperative bloodstream infection and surgical site infection was observed among patients with broad-spectrum antibiotic regimen after pediatric cardiac surgery with open chest management. Further studies, ideally randomized controlled studies investigating the efficacy of broad-spectrum antibiotics and their complications, are warranted before routine implementation of broad-spectrum prophylactic antibiotic regimen.
虽然开胸管理可以优化心脏手术后的血液动力学，但它会增加术后感染并导致死亡率增加。尽管开胸管理期间使用抗生素预防措施非常重要，但目前尚无具体建议。我们旨在比较不同开胸管理预防性抗生素方案后儿科心脏手术后血流感染和手术部位感染的发生率。
回顾性、单中心、观察性研究。
三级儿童医院的 PICU。
2012 年 1 月至 2018 年 6 月期间，在心脏手术后进行开胸管理并随后延迟胸骨闭合的年龄不超过 18 岁的连续患者。
无。
我们比较了三种预防性抗生素方案（头孢唑啉、头孢唑啉+万古霉素和万古霉素+美罗培南）后心脏手术后 30 天内术后血流感染和手术部位感染的复合发生率：1）头孢唑啉，2）头孢唑啉+万古霉素，和 3）万古霉素+美罗培南。在 63 例开胸管理的儿科心脏手术中，术后发现 17 例血流感染和 12 例手术部位感染。头孢唑啉、头孢唑啉+万古霉素和万古霉素+美罗培南方案中血流感染和手术部位感染的复合发生率分别为 10/15（67%）、10/19（53%）和 9/29（31%）（p=0.07）。在多变量分析中，调整年龄、开胸管理持续时间、体外膜氧合使用和鼻耐甲氧西林金黄色葡萄球菌定植后，头孢唑啉和头孢唑啉+万古霉素方案之间无显著差异（p=0.19），而万古霉素+美罗培南方案与头孢唑啉方案相比，血流感染和手术部位感染的发生率较低（比值比，0.0885；95%CI，0.0176-0.446；p=0.003）。
在这项研究中，在接受开胸管理的儿科心脏手术后接受广谱抗生素治疗的患者中，术后血流感染和手术部位感染的发生率较低。在常规实施广谱预防性抗生素方案之前，需要进行进一步的研究，理想情况下是随机对照研究，以评估广谱抗生素的疗效及其并发症。
