title: Sternal wound infections in pediatric congenital cardiac surgery: a survey of incidence and preventative practice.
abstract: BACKGROUND
  Guidelines exist for prevention of sternal wound infections (SWI) in adults. There are no guidelines for pediatric patients and limited reports on SWI incidence. The purpose of this study was to determine the incidence of, and preventative practice regarding pediatric SWIs with a long-term aim to develop best practice guidelines.
  
  
  METHODS
  Eighty-nine congenital heart programs were sent a 31 question on-line survey regarding pediatric SWI.
  
  
  RESULTS
  Thirty eight (43%) of the 89 programs responded. They reported 8,774 pediatric congenital procedures with a mean SWI rate of 1.53% (range, 0 to 9.09). Mean yearly volume was 237 operations (range, 50 to 720). Neither program size nor delayed sternal closure was associated with increased incidence of SWI. Variations in preoperative measures, antibiotic regimens, and wound care did not statistically impact incidence of SWI. Programs with protocols to monitor and control blood glucose levels postoperatively had statistically lower infection rates (1.04 vs 2.35, p = 0.03), and those that sent mediastinal cultures at time of delayed sternal closure reported lower infection rates (1.34 vs 1.74, p = 0.051).
  
  
  CONCLUSIONS
  This report provides a multiinstitutional SWI incidence from pediatric programs of 1.53%. Despite variations in clinical practice between programs, this survey revealed two strategies resulting in reduced SWIs; protocol-based management of glucose levels and mediastinal wound cultures sent at time of closure. Pediatric programs do not consistently follow adult preventative guidelines. Multicenter randomized research is needed to formulate preventative guidelines to reduce the incidence of pediatric SWI.
authors.affiliation: Department of Pediatrics, Division of Critical Care, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA. woodwardc@uthscsa.edu
authors.forename: Cathy S
authors.initials: CS
authors.lastname: Woodward
authors.forename: Minnette
authors.initials: M
authors.lastname: Son
authors.forename: John
authors.initials: J
authors.lastname: Calhoon
authors.forename: Joel
authors.initials: J
authors.lastname: Michalek
authors.forename: S Adil
authors.initials: SA
authors.lastname: Husain
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D011379:Prognosis; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology