Gentamicin-collagen sponge reduces sternal wound complications after heart surgery: A controlled, prospectively randomized, double-blind study

Schimmer, Christoph; Özkur, M.; Sinha, Bhanu; Hain, Johannes; Gorski, Armin; Hager, Benjamin H.; Leyh, Rainer

doi:10.1016/j.jtcvs.2011.05.035

Cited by 80 publications

(94 citation statements)

References 21 publications

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“…Some studies have reported that an antibiotic-collagen sponge was effective for the prevention of DSWI. However, the results from different studies have been controversial (12,13,28,29). In this study, we showed that the group treated with intravenous antibiotic, sternal debridement and flap reconstruction had a better prognosis than the group treated with intravenous antibiotic and sternal debridement (30)(31)(32)(33).…”

Section: Discussionmentioning

confidence: 80%

Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study

Pan¹,

Mo²,

Zhou³

et al. 2017

J. Thorac. Dis.

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Background: Deep sternal wound infection (DSWI) is a severe complication following cardiac surgery. A retrospective study was implemented to determine the risks and clinical characteristics of DSWI after cardiac operation in the Chinese population.Methods: We analysed 7,944 consecutive patients who underwent cardiac surgery via median sternotomy from January 2002 to December 2016 at our institution. Multiple logistic regression analysis was used to identify risk factors for DSWI.Results: A total of 106 patients (1.33%) suffered from DSWI; significant risk factors included body mass index (BMI) (P=0.02; OR=1.08; 95% CI: 1.01-1.16) and reoperation (P<0.01; OR=5.93; 95% CI: 2.88-12.25).The most common bacterium involved in DSWI was staphylococcus aureus (23%). Among all DSWI patients, the overall survival rate of the group treated with flap reconstruction was significantly higher than that in the group treated with intravenous antibiotics and sternal debridement (87% vs. 59%, P=0.01).Conclusions: DSWI was associated with several risk factors. Effective intervention strategies could improve the outcome of patients undergoing cardiac surgery.

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Section: Discussionmentioning

confidence: 80%

Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study

Pan¹,

Mo²,

Zhou³

et al. 2017

J. Thorac. Dis.

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“…Three of these trials demonstrated a decrease in SSIs and one showed no difference. [10][11][12][13][14] A recent meta-analysis combining these trials concluded that the risk of deep sternal wound infection was significantly lower in patients who received a gentamicin collagen sponge than in patients who did not (RR, 0.62 [95% CI, 0.39-0.97]) despite significant heterogeneity among the trials. 15 Hence, numerous studies with their significant findings advocate the use of topical antibiotic in reducing the rate of SSSI while others refute the routine use of topical antibiotics.…”

Section: Incidence Of Superficial Surgical Site Infection (Sssi)mentioning

confidence: 99%

Prospective study of surgical site infection in laparotomy wounds with antibiotic lavage

Chatterjee

Khaitan²,

Bhattacharya

et al. 2016

Int Surg J

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“…15,16 These findings were confirmed with another prospective randomized controlled trial in 2012 showing infection reduction from 3.5% to 0.56%. 39 However, 2 randomized controlled trials in 2005 and 2010 failed to show a significant change in infection with topical antibiotics.…”

Section: 3046mentioning

confidence: 99%

“…Large, prospective, randomized trials have shown that the application of topical gentamicin directly to sternal wounds in cardiac surgery has led to a significant reduction in infection rates. 15,16,39 Similarly, the use of vancomycin powder in posterior spinal fusion for trauma has shown reduced infection rates from as much as 13% to as low as 0%. 17,19 The application of concentrated antibiotics directly to surgical wounds during nonspinal neurosurgical procedures has been more limited.…”

mentioning

confidence: 99%

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

Beckman

Amankwah²,

Tetreault

et al. 2015

PED

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OBJECT The application of concentrated topical antibiotic powder directly to surgical wounds has been associated with a reduction in wound infection in cardiac, spinal, and deep brain stimulator surgery. As a result of these findings, the corresponding author began systematically applying concentrated bacitracin powder directly to wounds during shunt surgery more than 5 years ago. The object of this study was to evaluate the effectiveness of concentrated bacitracin powder applied directly to wounds prior to closure during cranial shunt surgery and to evaluate the association between shunt infection and other risk factors. A single surgeon’s cranial shunt surgery experience, equally divided between periods during which antibiotic powder was and was not applied, was studied to assess the effect of concentrated bacitracin powder application on shunt infection rates. METHODS This retrospective cohort study included all patients who underwent a cranial shunting procedure at All Children’s Hospital performed by a single surgeon (G.F.T.) from 2001 to 2013. The surgeon applied bacitracin powder to all shunt wounds prior to closure between 2008 and 2013, whereas no antibiotic powder was applied to wounds prior to 2008. Both initial and revision shunting procedures were included, and all procedures were performed at a large children’s hospital (All Children’s Hospital). The primary outcome measure was shunt infection, which was defined using clinical criteria previously used by the Hydrocephalus Clinical Research Network. The association between bacitracin powder use and shunt infection was estimated using hazard ratios (HRs) and 95% CIs from Cox proportional hazard regression models. RESULTS A total of 47 infections out of 539 shunt operations occurred during the study period, resulting in an overall infection rate of 8.7%. Procedures performed before the use of concentrated bacitracin powder was instituted resulted in a 13% infection rate, whereas procedures performed after systematic use of bacitracin powder had been adopted experienced a 1% infection rate. Bacitracin powder use was associated with a reduced risk of shunt infection in univariate analysis (HR 0.11, 95% CI 0.03–0.34, p = 0.0002) and also in multivariate analysis (HR 0.12, 95% CI 0.04–0.41, p = 0.0006) when controlling for covariates that were associated with infection from the univariate analysis. The presence of a tracheostomy or a gastrostomy tube was also found to be independently associated with shunt infection in multivariate analysis (HR 3.15, 95% CI 1.05–9.50, p = 0.04, and HR 2.82, 95% CI 1.33–5.96, p = 0.007, respectively). CONCLUSIONS This study suggests, for the first time, that the systematic application of concentrated bacitracin powder to surgical wounds prior to closure during shunt surgery may be associated with a reduction in cranial shunt infection. This initial finding requires validation in a large prospective study before widespread application can be advocated.

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Gentamicin-collagen sponge reduces sternal wound complications after heart surgery: A controlled, prospectively randomized, double-blind study

Abstract: Routine prophylactic retrosternal use of a gentamicin-collagen sponge in patients undergoing cardiac surgery significantly reduces deep sternal wound infections.

Cited by 80 publications

References 21 publications

Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study

Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study

Prospective study of surgical site infection in laparotomy wounds with antibiotic lavage

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

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