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Local gentamicin reduces sternal wound infections after cardiac surgery: a randomized controlled trial
Orjan Friberg1, Rolf Svedjeholm, Bo Söderquist
1Department of Cardiothoracic Surgery, Orebro University Hospital, Orebro, Sweden. orjan.friberg@orebroll.se
Background:
Sternal wound infections remain a major cause of morbidity after cardiac surgery. Vancomycin is often the only effective antibiotic available for their treatment but its use for routine prophylaxis is inadvisable for ecological reasons. Local application of gentamicin produces high antibiotic concentrations in the wound. We aimed to determine whether this treatment could have an additive effect on the incidence of sternal wound infections when combined with routine prophylaxis.
Methods:
Two thousand cardiac surgery patients were randomized to routine prophylaxis with intravenous isoxazolyl-penicillin alone (control group) or to this prophylaxis combined with application of collagen-gentamicin (260 mg gentamicin) sponges within the sternotomy before wound closure. Endpoint was any sternal wound infection within 2 months postoperatively. Evaluations were double-blind and made on an intention-to-treat basis.
Results:
Evaluation was possible in 967 and 983 patients in the control and treatment groups, respectively. The incidence of sternal wound infection was 4.3% in the treatment group and 9.0% in the control group (relative risk 0.47; 95% confidence interval 0.33-0.68; p < 0.001). Early reoperation for bleeding was more common in the treatment group (4.0% vs 2.3%, p = 0.03). No difference in postoperative renal function was noted.
Conclusions:
Local collagen-gentamicin reduced the risk for postoperative sternal wound infections. Further studies are warranted to confirm these results, particularly with regard to deep infections.
Insights
Local collagen-gentamicin sponges significantly reduced sternal wound infections after cardiac surgery. This treatment offers a promising strategy to improve patient outcomes and decrease infection rates in surgical settings.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Control
- Surgical Site Infections
Background:
- Sternal wound infections are a significant complication following cardiac surgery.
- Vancomycin is effective but its routine prophylactic use is discouraged.
- Local gentamicin application achieves high wound antibiotic concentrations.
Purpose of the Study:
- To evaluate the additive effect of local collagen-gentamicin sponges on sternal wound infection incidence.
- To compare outcomes between routine prophylaxis alone and combined with local gentamicin.
Main Methods:
- 2000 cardiac surgery patients were randomized.
- Intervention group received intravenous isoxazolyl-penicillin plus collagen-gentamicin sponges.
- Control group received intravenous isoxazolyl-penicillin alone.
- Sternal wound infection incidence was assessed within 2 months postoperatively.
Main Results:
- Sternal wound infection incidence was 4.3% in the treatment group versus 9.0% in the control group (RR 0.47, p < 0.001).
- Early reoperation for bleeding was more frequent in the treatment group (4.0% vs 2.3%, p = 0.03).
- No significant difference in postoperative renal function was observed between groups.
Conclusions:
- Local collagen-gentamicin application effectively reduced the risk of postoperative sternal wound infections.
- Further research is needed to validate these findings, especially for deep sternal infections.