Application of Continuous Local Antibiotic Perfusion for Postoperative Mediastinitis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Antimicrobial Therapy

Background:

• Postoperative mediastinitis is a serious complication of cardiovascular surgery, leading to increased mortality and prolonged hospital stays.
• Continuous local antibiotic perfusion (CLAP) is an emerging antimicrobial administration route, previously successful in orthopedic surgery.

Purpose of the Study:

• To evaluate the efficacy and safety of CLAP for treating mediastinitis following cardiovascular surgery.

Main Methods:

• Retrospective analysis of seven patients with cardiovascular surgery-associated mediastinitis treated with CLAP.
• Wound management involved debridement, Salem sump tubes, and negative pressure therapy with gentamicin perfusion (1.2 mg/mL at 2 mL/h).
• Infections were primarily caused by methicillin-resistant Staphylococcus aureus and Pseudomonas.

Main Results:

• No hospital mortality was observed; all patients achieved sternal closure without severe adverse events.
• The median duration of CLAP was 14 days, with early extubation (2.5 days) and oral feeding resumption (3.3 days).
• Three-year survival rate was 75% with a 100% reinfection-free rate; no gentamicin-related adverse events occurred.

Conclusions:

• CLAP is a safe and effective treatment for cardiovascular surgery-associated mediastinitis.
• The technique facilitates early patient recovery, including extubation, ambulation, and oral intake, aiding infection control.
• CLAP offers a promising approach to manage this challenging postoperative complication.