title: Bloodstream infections after median sternotomy at a children's hospital.
abstract: OBJECTIVE
  Postoperative bloodstream infections are a major source of morbidity and increased health care costs. In adults, mediastinitis has been described as a risk factor for bloodstream infections. The objectives of this retrospective cohort study were to determine the incidence and to identify risk factors for postoperative bloodstream infections among children after median sternotomy in an urban tertiary care children's hospital.
  
  
  METHODS
  For this study, 192 patients were randomly selected from among all patients undergoing median sternotomy between January 1, 1995, and December 31, 2003.
  
  
  RESULTS
  Ninety-eight (51%) of the 192 eligible patients were male. The median patient age was 5.4 months (interquartile range: 1 day-41.5 years). Bloodstream infections occurred in 12 (6.3%; 95% confidence interval [CI]: 3.3%-10.7%) patients within the first 30 days after median sternotomy. Bloodstream infections developed a median of 11 days (range: 3-29 days) after median sternotomy. Gram-negative bacilli caused 6 (50%) of the 12 bloodstream infections. Specific causes of bloodstream infections included Pseudomonas aeruginosa (n = 3), coagulase-negative staphylococci (n = 3), Pseudomonas fluorescens-putida (n = 2), Staphylococcus aureus (n = 2), Serratia marcescens (n = 1), and Candida albicans (n = 1). Multivariable analysis revealed that the development of mediastinitis (odds ratio [OR], 28.16; 95% CI, 3.37-235.22) and the requirement for postoperative extracorporeal membrane oxygenation (OR, 12.52; 95% CI, 2.99-52.41) were associated with bloodstream infections after median sternotomy.
  
  
  CONCLUSIONS
  Postoperative bloodstream infections occurred in 6.3% of children undergoing median sternotomy. Postoperative mediastinitis and the requirement for extracorporeal membrane oxygenation were risk factors for bloodstream infections after median sternotomy. These findings warrant exploration in a larger, multicenter study.
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. shahs@email.chop.edu
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Jessica
authors.initials: J
authors.lastname: Kagen
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
authors.forename: Warren B
authors.initials: WB
authors.lastname: Bilker
authors.forename: Jennifer
authors.initials: J
authors.lastname: Matro
authors.forename: Troy E
authors.initials: TE
authors.lastname: Dominguez
authors.forename: Sarah
authors.initials: S
authors.lastname: Tabbutt
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Louis M
authors.initials: LM
authors.lastname: Bell
mesh_terms: D017677:Age Distribution; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D017848:Blood-Borne Pathogens / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008480:Mediastinitis / Q000453:epidemiology* / Q000382:microbiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*