Infections in the immediate postoperative period of pediatric cardiac surgery: A narrative review
DOI:
https://doi.org/10.33448/rsd-v14i7.49260Keywords:
Thoracic Surgery, Surgical Wound Infection, Pediatrics, Critical Care, Antibiotic Prophylaxis.Abstract
Postoperative infections in the immediate period following pediatric cardiac surgery represent a significant cause of morbidity and mortality, worsening clinical outcomes and increasing healthcare costs. Despite technical and therapeutic advances, the immunological vulnerability of neonates and the complexity of cardiac procedures favor the occurrence of early infectious complications. This study aims to conduct a narrative review of recent scientific literature on infections in the immediate postoperative period of pediatric cardiac surgeries. A narrative review was performed based on 18 articles published between 2020 and 2025, retrieved from scientific databases and selected according to predefined inclusion and exclusion criteria. The results showed that bloodstream infections, surgical site infections, ventilator-associated pneumonias, sepsis, and fungal infections were the most prevalent. Major risk factors included delayed sternal closure, prolonged mechanical ventilation, extended surgical time, need for ECMO, and the presence of invasive devices. Prevention strategies based on bundles, rational antibiotic prophylaxis, environmental control, and multiprofessional education proved effective in reducing cases. Treatment involved empirical antibiotic therapy guided by culture results and, in fungal cases, the use of specific antifungal agents. It is concluded that the adoption of standardized, evidence-based strategies is essential to reduce the incidence and severity of immediate postoperative infections in pediatric cardiac surgeries.
References
Bavare, A., Rissmiller, B., Devaraj, S., Guffey, D., Rajapakshe, D., Weiner, H., . . . Shekerdemian, L. (2021). Perioperative procalcitonin in predicting infection in children undergoing surgical procedures. journal of surgical research, 258, 332-338.
Beshir, M. N., Ahmed, M., Tsega, T., & Getahun, T. (2024). Magnitude and Risk Factors for Paediatric Congenital Heart Surgery Complication and its association with Patient Outcomes in the Cardiac Center of Ethiopia. Ethiopian Journal of Health Sciences, 34(4).
Bianchini, S., Nicoletti, L., Monaco, S., Rigotti, E., Corbelli, A., Colombari, A., . . . De Luca, M. (2022). Peri-Operative prophylaxis in patients of neonatal and pediatric age subjected to cardiac and thoracic surgery: A RAND/UCLA Appropriateness Method Consensus study. Antibiotics, 11(5), 554.
Burzyńska, J., Jaworski, R., Maruszewski, B., Kansy, A., & Dzierżanowska-Fangrat, K. (2022). Perioperative Antibiotic Prophylaxis in Pediatric Cardiac Surgery—Simple Is Better. Antibiotics, 12(1), 66.
Campbell, M. M., Turi, J., Collier, S., English, C., Sistla, V., Smith, M. J., . . . Lewis, S. S. (2025). Implementation of bundled interventions to reduce surgical site infections in pediatric patients undergoing cardiothoracic surgery: a quality improvement project. AORN journal, 121(2), 127-139.
Caruso, T. J., Wang, E. Y., Schwenk, H., Marquez, J. L. S., Cahn, J., Loh, L., . . . Sharek, P. J. (2019). A postoperative care bundle reduces surgical site infections in pediatric patients undergoing cardiac surgeries. The Joint Commission Journal on Quality and Patient Safety, 45(3), 156-163.
Casarin, S. T., Porto, A. R., Gabatz, R. I. B., Bonow, C. A., Ribeiro, J. P., & Mota, M. S. (2020). Tipos de revisão de literatura: considerações das editoras do Journal of Nursing and Health/Types of literature review: considerations of the editors of the Journal of Nursing and Health. Journal of nursing and health, 10(5).
Cavalcante, E. F. d. O., Pereira, I. R. B. d. O., Leite, M. J. V. d. F., Santos, A. M. D., & Cavalcante, C. A. A. (2019). Implementação dos núcleos de segurança do paciente e as infecções relacionadas à assistência à saúde. Revista Gaúcha de Enfermagem, 40(spe), e20180306.
Elassal, A. A., Al-Radi, O. O., Debis, R. S., Zaher, Z. F., Abdelmohsen, G. A., Faden, M. S., . . . Abdulgawad, A. M. (2022). Neonatal congenital heart surgery: contemporary outcomes and risk profile. Journal of Cardiothoracic Surgery, 17(1), 80.
Fadaly, A. S., Abdellatif, G. M., Saeed, S. E., Brik, A., Elsharawy, M., Deebis, A., . . . Shemais, D. S. (2022). Efficacy of Primary Closure Technique in Treatment of Post-Sternotomy Mediastinitis in Paediatric Group: A Randomized Controlled Trial. International Journal of General Medicine, 15, 7929.
Jaworski, R., Kansy, A., Dzierzanowska-Fangrat, K., & Maruszewski, B. (2019). Antibiotic prophylaxis in pediatric cardiac surgery: where are we and where do we go? A systematic review. Surgical infections, 20(4), 253-260.
Kato, Y., Shime, N., Hashimoto, S., Nomura, M., Okayama, Y., Yamagishi, M., & Fujita, N. (2007). Effects of controlled perioperative antimicrobial prophylaxis on infectious outcomes in pediatric cardiac surgery. Critical care medicine, 35(7), 1763-1768.
Kawamura, J., Ueno, K., Taimura, E., Matsuba, T., Imoto, Y., Jinguji, M., & Kawano, Y. (2021). Case report: 18F-FDG PET-CT for diagnosing prosthetic device-related infection in an infant with CHD. Frontiers in Pediatrics, 9, 584741.
Klepacka, J., Zakrzewska, Z., Czogała, M., Wojtaszek-Główka, M., Krzysztofik, E., Czogała, W., & Skoczeń, S. (2022). Fungal Infection Testing in Pediatric Intensive Care Units—A Single Center Experience. International Journal of Environmental Research and Public Health, 19(3), 1716.
Lupatini, E. D. O., Melo, O., Santana, R., & Sena, R. (2017). Assistência Farmacêutica em Pediatria no Brasil: recomendações e estratégias para a ampliação da oferta, do acesso e do Uso Racional de Medicamentos em crianças: Editora Ministério da Saúde.
Mehta, P. A., Cunningham, C. K., Colella, C. B., Alferis, G., & Weiner, L. B. (2000). Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. The Pediatric infectious disease journal, 19(10), 1000-1004.
Mendes, E. V. (2010). As redes de atenção à saúde. Ciência & saúde coletiva, 15, 2297-2305.
Mota, É. C., Barbosa, D. A., da Silveira, B. R. M., Rabelo, T. A., Silva, N. M., da Silva, P. L. N., . . . Gonçalves, R. P. F. (2014). Higienização das mãos: uma avaliação da adesão e da prática dos profissionais de saúde no controle das infecções hospitalares. Revista de epidemiologia e Controle de infecção, 4(1), 12-17.
Partridge, E., Dodson, D., Reilly, M., & Cohen, S. H. (2023). Aspergillus Mediastinitis & Endocarditis in a Pediatric Patient Complicating Cardiac Surgery and Bedside Chest Closure. WebM&M: Case Studies [Internet].
Pereira, A. S., Shitsuk, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica: UFSM.
Perl, T. M., Cullen, J. J., Wenzel, R. P., Zimmerman, M. B., Pfaller, M. A., Sheppard, D., . . . Team, t. R. o. S. a. S. (2002). Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. New England Journal of Medicine, 346(24), 1871-1877.
Philip, J., Kegg, C., Lopez-Colon, D., Kelly, B. J., Lawrence, R. M., Robinson, M. A., . . . Bleiweis, M. S. (2020). Safety of a 2-day antibiotic regimen after delayed chest closure post pediatric cardiac surgery. Journal of intensive care medicine, 35(8), 805-809.
Pilarczyk, K., Rath, P.-M., Steinmann, J., Thielmann, M., Padosch, S. A., Dürbeck, M., . . . Dusse, F. (2019). Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery. BMC anesthesiology, 19, 1-11.
Prendin, A., Tabacco, B., Fazio, P. C., & De Barbieri, I. (2021). Management of pediatric cardiac surgery wound: a literature review. Acta Bio Medica: Atenei Parmensis, 92(4), e2021203.
Ribeiro, A. C. d. L., Siciliano, R. F., Lopes, A. A., & Strabelli, T. M. V. (2023a). Fatores de risco para infecção da ferida operatória em pacientes submetidos à cirurgia cardíaca pediátrica. Arquivos Brasileiros de Cardiologia, 120(12), e20220592.
Ribeiro, A. C. d. L., Siciliano, R. F., Lopes, A. A., & Strabelli, T. M. V. (2023b). Risk factors for surgical site infection in patients undergoing pediatric cardiac surgery. Arquivos Brasileiros de Cardiologia, 120, e20220592.
Rother, E. T. (2007). Revisión sistemática X Revisión narrativa. Acta paulista de enfermagem, 20, v-vi.
Sandoval, N., Kreutzer, C., Jatene, M., Sessa, T. D., Novick, W., Jacobs, J. P., . . . Tchervenkov, C. I. (2010). Pediatric cardiovascular surgery in South America: current status and regional differences. World Journal for pediatric and congenital heart surgery, 1(3), 321-327.
Savary, L., De Luca, A., El Arid, J.-M., Ma, I., Soule, N., Garnier, E., . . . Lefort, B. (2022). Systematic skin and nasal decolonization lowers Staphylococcus infection in pediatric cardiac surgery. Archives de Pédiatrie, 29(3), 177-182.
Sen, A. C., Morrow, D. F., Balachandran, R., Du, X., Gauvreau, K., Jagannath, B. R., . . . Chau, N. T. (2017). Postoperative infection in developing world congenital heart surgery programs: data from the International Quality Improvement Collaborative. Circulation: Cardiovascular Quality and Outcomes, 10(4), e002935.
Silvetti, S., Landoni, G., Castagnola, E., Nuri, H., Pomé, G., & Moscatelli, A. (2020). Antibiotic management for delayed sternal closure following pediatric cardiac surgery: a systematic review of recent literature. Journal of cardiothoracic and vascular anesthesia, 34(5), 1333-1340.
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of business research, 104, 333-339.
Suvorov, V. V., & Ivanov, D. O. (2024). Risk Factors for Surgical Site Infection After Cardiac Surgery in Neonates: A Case–Control Study. Journal of Clinical Medicine, 13(24), 7755.
Turcotte, R. F., Brozovich, A., Corda, R., Demmer, R. T., Biagas, K. V., Mangino, D., . . . Bacha, E. (2014). Health care-associated infections in children after cardiac surgery. Pediatric cardiology, 35, 1448-1455.
Vachirapuranon, S., Vijarnsorn, C., Kanjanauthai, S., Tocharoenchok, T., Durongpisitkul, K., Chanthong, P., . . . Rungmaitree, S. (2022). Major infections following pediatric cardiac surgery pre-and post-CLABSI bundle implementation. PeerJ, 10, e14279.
Van Der Linde, D., Konings, E. E., Slager, M. A., Witsenburg, M., Helbing, W. A., Takkenberg, J. J., & Roos-Hesselink, J. W. (2011). Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. Journal of the American College of Cardiology, 58(21), 2241-2247.
von Stumm, M., Leps, Y., Jochheim, L., van Rüth, V., Gottschalk, U., Mueller, G., . . . Biermann, D. (2022). Impact of delayed sternal closure on wound infections following neonatal and infant cardiac surgery. PLoS One, 17(5), e0267985.
Wang, Q., Liu, H., Zou, L., Cun, Y., Shu, Y., Patel, N., . . . Mo, X. (2024). Early predictors of bacterial pneumonia infection in children with congenital heart disease after cardiopulmonary bypass: a single-centre retrospective study. BMJ open, 14(3), e076483.
Williamson, K. C., & Fabbri, D. (2023). Classifying Infection Risk Following Pediatric Cardiac Surgery. Paper presented at the AMIA Annual Symposium Proceedings.
Zhang, L., & Guleng, W. (2023). Risk Factors of Postoperative Infection in Newborns with Congenital Heart Disease. Paper presented at the The Heart Surgery Forum.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Ítala Karine Campos Barros; Thamys Marinho Melo; Fabrício Silva Pessoa
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
