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Role of vacuum in methicillin-resistant deep sternal wound infection
Marisa De Feo1, Mariano Vicchio, Gianantonio Nappi
1Department of Cardiothoracic Sciences, Second University of Naples, V Monaldi Hospital, Italy.
Abstract:
Between January 2002 and January 2009, 39 patients with post-cardiotomy staphylococcal deep sternal wound infection were treated primarily by a vacuum-assisted closure method (group A). Results were compared with those of 30 patients with staphylococcal deep sternal wound infection who received closed mediastinal irrigation with antibiotics (group B). The prevalence of methicillin-resistance was similarly high in both groups (64.1% in A, 56.7% in B). One group B patient died during treatment. The median healing time was significantly shorter at 13 days in group A (mean, 13.5 +/- 3.2 days) compared to 18 days (mean, 21.2 +/- 16.4 days) in group B. Deep sternal wound infection did not recur after vacuum treatment, while 7 (24%) patients in group B suffered a recurrence. Hospital stay was significantly shorter in group A (median, 30.5 days; mean, 32.2 +/- 11.3 days vs. median, 45 days; mean, 49.2 +/- 19.3 days). The significantly shorter healing time with vacuum-assisted closure was confirmed in both methicillin-sensitive (12 vs. 17 days) and methicillin-resistant infections (14 vs. 21 days). Hospital stay remained significantly shorter in group A (35 vs. 46 days) when only methicillin-resistant deep sternal wound infection was considered.
Insights
Vacuum-assisted closure significantly reduces healing time and hospital stays for deep sternal wound infections following heart surgery. This method also prevents recurrence, offering a superior treatment for staphylococcal infections.
Area of Science:
- Medical Sciences
- Surgical Innovation
- Infectious Diseases
Background:
- Deep sternal wound infection (DSWI) is a serious complication after cardiotomy.
- Staphylococcal infections, including methicillin-resistant strains, are common causes of DSWI.
- Traditional treatments like closed mediastinal irrigation have limitations.
Purpose of the Study:
- To compare the efficacy of vacuum-assisted closure (VAC) versus closed mediastinal irrigation with antibiotics for treating post-cardiotomy staphylococcal DSWI.
- To evaluate healing time, recurrence rates, and hospital stay duration for both treatment methods.
Main Methods:
- A retrospective study comparing 39 patients treated with VAC (Group A) and 30 patients treated with antibiotic irrigation (Group B) for staphylococcal DSWI.
- Inclusion criteria: post-cardiotomy staphylococcal DSWI.
- Outcome measures: healing time, recurrence, and hospital stay.
Main Results:
- VAC treatment resulted in a significantly shorter median healing time (13 days) compared to antibiotic irrigation (18 days).
- No recurrences were observed in the VAC group, versus 24% in the antibiotic irrigation group.
- Hospital stay was significantly shorter for VAC patients (median 30.5 days) compared to the antibiotic group (median 45 days).
- These benefits were consistent for both methicillin-sensitive and methicillin-resistant Staphylococcus infections.
Conclusions:
- Vacuum-assisted closure is a highly effective treatment for post-cardiotomy staphylococcal deep sternal wound infections.
- VAC offers significant advantages in terms of faster healing, reduced recurrence, and shorter hospital stays.
- This method provides a superior alternative to traditional antibiotic irrigation for managing these challenging infections.
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