Clinical Relevance of Positive Bacterial Samples in Perioperative Pediatric Cardiac Surgery—A Retrospective Evaluation over 5 Years

Background: In January 2019, we modified our perioperative standard for infectious prophylaxis to one dose of cefuroxime pre- and postoperatively. We evaluated this new standard after two years with the focus on changes of positive bacterial samples in the perioperative phase up to 14 days postoperatively. If required, we might adapt our hygienic and prophylactic approach.

Methods: Within the setting of a retrospective study design, we analyzed all pediatric cardiac surgical patients over a five years’ period (2016–2020) by means of digital patient records. We focused on all perioperative findings of collected samples, including blood cultures, urine cultures, throat swabs, cultures of tracheal secretions, anal swabs and bacterial samples associated with foreign bodies (especially central venous lines). We compared the period between 2016 and 2018 (period before the introduction of the new standard) with the years 2019 and 2020.

Results: In total, 342 datasets were available for analysis—consisting of 182 boys and 160 girls or 261 surgical procedures on cardiopulmonary bypass and 81 without. The predominant portion of the positive bacterial samples consisted of colonizations rather than real infections. Taking into account selected bacteria, we recognized a slight decrease of positive cultures over the years with the exception of Staphylococcus aureus in throat swabs. The shortened perioperative antibiotic prophylaxis did not result in an increase in postoperative infections. In addition, we could not detect a significant shift in terms of multi-resistant bacteria between pre- and postoperative samples.

Conclusion: The shortened duration of the perioperative prophylaxis of infections with only one dose of cefuroxime given pre- and postoperatively had no significant impact on the incidence of postoperative infections. Taking into account the very low rate of postoperative infections, this does not result in any changes in the hygienic and prophylactic approach. Nevertheless, periodical evaluations should continue to ensure prevention against postoperative infections.