Topical Vancomycin and Risk of Sternal Wound Infections: A Double-Blind Randomized Controlled Trial

Area of Science:

• Cardiovascular Surgery
• Infectious Disease Prevention
• Clinical Trials

Background:

• Sternal wound infection (SWI) is a significant complication after cardiac surgery.
• Previous evidence on topical vancomycin for SWI prevention was limited to observational studies and an unblinded trial.
• The efficacy of vancomycin in reducing SWI risk remains a subject of debate.

Purpose of the Study:

• To evaluate the effectiveness of topical vancomycin in reducing the incidence of sternal wound infections (SWI) in cardiac surgery patients.
• To provide high-quality evidence through a double-blind randomized controlled trial.
• To clarify the role of vancomycin in preventing SWI.

Main Methods:

• A double-blind randomized controlled trial was conducted involving 1037 patients undergoing cardiac surgery.
• Patients were randomized to receive either vancomycin-soaked or saline-soaked sponges applied to the sternum.
• Sternal wound infection incidence was assessed at 3 months and 1 year postoperatively.

Main Results:

• No significant difference in SWI incidence was observed between the vancomycin and control groups at 3 months (2.7% vs 4.1%, P = .23) or at 1 year.
• The study found no significant difference in the risk of superficial, deep, or organ-space infections between the groups.
• Coagulase-negative Staphylococcus was the most frequently isolated organism.

Conclusions:

• Topical vancomycin applied to the sternum during cardiac surgery does not reduce the incidence of sternal wound infections (SWI).
• The findings do not support the routine use of vancomycin-soaked sponges for SWI prevention in this patient population.
• Further research may explore alternative strategies for SWI prophylaxis.