Antibiotic management for delayed sternal closure following pediatric cardiac surgery. A systematic review of recent literature

Abstract Objective Delayed sternal closure after pediatric cardiac surgery is a management option for the treatment of patients with severely impaired heart function. Even if it can increase the risk of infections, the optimal antimicrobial treatment strategy for this condition is unknown. Aim of this systematic review was to evaluate the current antibiotic administration attitudes in pediatric cardiac surgery patients needing open chest in term of infection with a focus on surgical site infection rate. Materials We performed a systematic review and meta-analysis of all articles which described the antibiotic administration strategy and surgical site infection rate in pediatric patients with open chest after cardiac surgery. We performed a sub-group analysis on “standard” vs “non-standard” (defined as any antimicrobial drugs different from the adult guidelines recommendations) therapy for one-proportion meta-analysis with a random effect model. Results We identified 12 studies published from January 1 st 2005 to July 1 st 2019 including a total of 2,203 patients requiring open chest after cardiac surgery, 350 of whom (15,9%) developed infections and 182 (8,3%) developed surgical site infection. The surgical site infection rate in patients with “non-standard” strategy was higher than in patients with “standard” strategy: 8,8% (140 reported infections/1582 patients) vs 6,8% (42 reported infections/621 patients), p=0.001. Conclusion The “standard” antibiotic management proposed by guidelines for adult cardiac surgery patients could be used as an acceptable strategy to treat pediatric patients with open chest after cardiac surgery.