Delayed sternal closure after pediatric cardiac surgery is a management option for the treatment of patients with severely impaired heart function. The optimal antimicrobial treatment strategy for this condition is unknown. The aim of this systematic review was to evaluate the current
antibiotic administration attitudes in pediatric cardiac surgery patients needing an open chest in terms of
infection with a focus on
surgical site infection rate. The authors 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 an open chest after cardiac surgery. The authors performed a subgroup analysis on "standard" versus "non-standard" (defined as any antimicrobial drugs different from the adult guidelines recommendations)
therapy for one-proportion meta-analysis with a random effect model. The authors identified 12 studies published from January 1, 2000 to July 1, 2019 including a total of 2,203 patients requiring an open chest after cardiac surgery, 350 of whom (15.9%) developed
infections and 182 (8.3%) developed a
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/1,582 patients) versus 6.8% (42 reported
infections/621 patients), p = 0.001. The "standard"
antibiotic management proposed by guidelines for adult cardiac surgery patients could be used an acceptable strategy to treat pediatric patients with an open chest after cardiac surgery.