Background and aims Surgical site infections after median sternotomy and repair of congenital heart diseases are rare but have a high morbidity and mortality in paediatric patients. These patients may require repeated surgical procedures including sternal debridement. We present a case who had chronic Escherichia coli surgical site infection and mediastinitis after complete repair of tetralogy of Fallot.

Methods A 2.7-year-old boy who underwent an uneventful surgical total correction procedure for tetralogy of Fallot 9 months before, was referred to our centre because of fever and swelling on sternal incision. Infective endocarditis was ruled out by echocardiographic examination. After ampicillin/sulbactam and clindamycin treatment, the abscess spontaneously drained. Cultures were positive for ESBL-producing E. coli. He had sternal debridement, appropriate antibiotic therapy and was discharged from hospital.

Results Six months later, he was admitted because of effluent from sternal incision scar. MRI of mediastinum revealed a deep sternal wound infection. ESBL-positive E. coli was isolated in cultures taken from the suppurative effluent. Mediastinitis was confirmed by exploratory sternotomy. Cultures of blood and mediastinal swabs were positive for the same organism. The child had an uneventful recovery after the surgical and medical treatment.

Conclusions Mediastinitis should also be considered in patients with sternal wound infections after heart surgery. Aggresive surgical and medical treatment is essential.