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Treatment of gram-positive deep sternal wound infections in cardiac surgery--experiences with daptomycin

Aron F Popov1, Jan D Schmitto, Ahmad F Jebran

  • 1Department of Thoracic Cardiovascular Surgery, University of Göttingen, Germany. A.Popov@rbht.nhs.uk

Journal of Cardiothoracic Surgery
|September 21, 2011
PubMed

Insights

Daptomycin treatment effectively manages deep sternal wound infections (DSWI) after cardiac surgery. This antibiotic regimen led to significant infection marker reduction and successful wound healing in all patients.

Area of Science:

  • Infectious Diseases
  • Cardiovascular Surgery
  • Pharmacology

Background:

  • Deep sternal wound infection (DSWI) following cardiac surgery occurs in 0.4-5% of cases, primarily caused by Staphylococcus aureus.
  • DSWI significantly increases patient morbidity and mortality, with limited established antibiotic management protocols.
  • Optimal antibiotic strategies for DSWI, particularly with gram-positive organisms, require further investigation.

Purpose of the Study:

  • To evaluate the efficacy and safety of daptomycin in treating DSWI caused by gram-positive organisms after cardiac surgery.
  • To quantify the application and outcomes of daptomycin treatment in this patient population.

Main Methods:

  • An observational analysis of 23 patients with post-sternotomy DSWI due to gram-positive organisms between February 2009 and September 2010.
  • Individualized chest closure techniques were employed for viable wounds with negative cultures.
  • Daptomycin treatment was administered, with Vacuum-Assisted Closure (VAC) therapy used in 89% of cases.

Main Results:

  • The incidence of DSWI in the study cohort was 1.46%.
  • Mean daptomycin dose was 4.4 mg/kg/d for a mean duration of 14.47 days.
  • Significant reductions in fibrinogen (p=0.03), white blood cell count (p=0.001), and C-reactive protein (p=0.0001) were observed post-treatment.
  • All patients achieved successful wound healing with no mortality.

Conclusions:

  • Daptomycin-containing regimens are safe and effective for treating DSWI caused by gram-positive organisms post-cardiac surgery.
  • Daptomycin promotes rapid improvement in local wound conditions and facilitates surgical management.
  • Daptomycin represents a promising therapeutic option for expediting DSWI treatment.

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