Efficacy of topical vancomycin application in cardiac surgery to reduce deep sternal wound infection: a randomised control trial at tertiary cardiac care hospital

Abstract

Background: Mediastinitis is lethal complication and a challenge in post cardiac surgery patients. We aim at evaluation of topical vancomycin by applying it at sternal edge in prevention of deep sternal wound infection.Methods: The vancomycin group had local application of vancomycin paste prepared by mixing 1gm of powder in 3 ml of normal saline and stirred until paste was formed. The control group had reinforced closure technique without vancomycin paste application. All cases were followed up for symptoms and signs of sternal wound infection during hospital stay and uptil 1 month.Results: There was increase incidence of wound infection with control group as compared to vancomycin group, there were no wound infection in patients of vancomycin group.Conclusions: Application of topical vancomycin significantly reduces post-sternotomy wound infection and prevents deep mediastinitis.

A meta‐analysis examined the effect of topical vancomycin application in decreasing sternal wound infections post cardiac surgery

“…Twenty‐three thousand seven hundred and forty five participants with CS were enrolled in the chosen studies; 8730 of them used TV, while 15 015 served as controls. From a total of 1054 applicable studies that were appraised, 10 papers between 1989 and 2022 that met the inclusion criteria and were encompassed in the meta‐analysis were selected 7,14‐22 …”

“…At the start of the investigations, 23 745 participants had CS at the start of the examination; 8730 of them used TV, while 15 015 were control. 7,[14][15][16][17][18][19][20][21][22] The TV had significantly lower SWIs, and deep SWIs post CS compared with control. However, there was no significant difference found between TV and control in superficial SWIs post CS.…”

“…At the start of the investigations, 23 745 participants had CS at the start of the examination; 8730 of them used TV, while 15 015 were control 7,14‐22 . The TV had significantly lower SWIs, and deep SWIs post CS compared with control.…”

Intrawound Vancomycin Powder Application for Preventing Surgical Site Infection Following Cranioplasty

“…The patients in this study experienced no adverse events associated with the use of intrawound vancomycin, which is consistent with other published studies including cardiac and cranial surgeries. 7,22,24,25 However, several local (wound dehiscence, wound seroma, delayed wound healing, neuritis, and pseudoarthrosis) and systemic (anaphylactic reaction, renal toxicity, and ototoxicity) adverse events have been reported in spinal and orthopedic surgeries in which the effect and safety of intrawound vancomycin powder were most extensively evaluated. 5,6,8,11,17,21 Therefore, as recommended in these surgical fields, minimizing the amount of vancomycin powder and hemovac line placement for avoiding an over-concentration of vancomycin in the wound can be helpful for reducing adverse events.…”

“…5 Given that the most common organisms associated with surgical site infections are gram-positive bacteria, intrawound vancomycin has been applied in various surgical procedures including cardiac, orthopedic, and spine operations, and showed its effects and safety. 5,7,10,20,21,25,28 Based on this background, we have been using intrawound vancomycin powder in cranioplasty. The purpose of this study was to evaluate the effect of intrawound vancomycin powder application for preventing surgical site infection following cranioplasty compared with the conventional procedure without topical antibiotics.…”