title: Bloodstream infections increased after delayed sternal closure: cause or coincidence.
abstract: BACKGROUND
  Infants who undergo major cardiac operations are at risk for developing bloodstream infections which contribute to the morbidity, mortality, and cost of treatment. Determining what factors are associated with this increased risk of infection may aid in prevention. We sought to evaluate the practice of delayed sternal closure after neonatal cardiac surgery to determine its role as a risk factor for postoperative bloodstream infection.
  
  
  METHODS
  We reviewed 110 consecutive patients with hypoplastic left heart syndrome after stage 1 Norwood procedure at Children's Healthcare of Atlanta. The rates of bloodstream infections were determined and risks analyzed with regard to postoperative status of sternal closure; primary versus delayed.
  
  
  RESULTS
  Delayed sternal closure was utilized in 67 of 110 patients (61%), while 43 patients had primary sternal closure in the operating room. Overall rate of bloodstream infection was 22% (24 of 110), with 83% (20 of 24) of infections occurring in the delayed closure group. Among infants with delayed closure, 30% developed bloodstream infection, as compared with 9% of patients with primary closure (p = 0.017). Patients with delayed closure had a fourfold increased risk (odds ratio 3.9, p = 0.03) of developing bloodstream infection in-hospital. Predominant organisms were coagulase negative Staphylococcus species; there was one case of mediastinitis.
  
  
  CONCLUSIONS
  Delayed sternal closure is associated with an increased likelihood of bloodstream infection and should be recognized as a risk factor after neonatal cardiac operations.
authors.affiliation: Department of Pediatric Cardiology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA.
authors.forename: Srikant
authors.initials: S
authors.lastname: Das
authors.forename: Agustin
authors.initials: A
authors.lastname: Rubio
authors.forename: Janet M
authors.initials: JM
authors.lastname: Simsic
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kirshbom
authors.forename: Brian
authors.initials: B
authors.lastname: Kogon
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Kanter
authors.forename: Kevin
authors.initials: K
authors.lastname: Maher
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D015994:Incidence; D007231:Infant, Newborn; D058327:Norwood Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D013529:Surgical Wound Dehiscence / Q000150:complications* / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*