Reduction of sternal infection by application of topical vancomycin

Post-sternotomy mediastinitis in the modern era

“…Vancomycin has also been used to reduce DSWI. Vander Salm and colleagues, in a prospective, randomized study, demonstrated that topical application of vancomycin paste to the cut sternal edges resulted in a significant decrease in DSWI (0.45% vs. 3.6%, P = 0.02) . Lazar and colleagues studied the effect of topical vancomycin to reduce the incidence of sternal wound infections in the presence of peri‐operative intravenous antibiotics and tight glycemic control.…”

Gentamicin collagen sponges for the prevention of sternal wound infection: A meta-analysis of randomized controlled trials

“…24 Other strategies that may aid in reducing SWI rates include strict glucose management, nasopharyngeal decontamination with mupirocin, skin decontamination with chlorhexidine showers, and topical application of antibiotics (ie, bacitracin or vancomycin) postoperatively. 25,26…”

Local Antimicrobial Administration for Prophylaxis of Surgical Site Infections

“…Despite this fact, results from 1016 PHARMACOTHERAPY Volume 32, Number 11, 2012 only one prospective trial evaluating the usefulness of vancomycin paste for SSP in patients undergoing sternotomy have been published. 43 This trial concluded that vancomycin paste is an effective method of SSP in cardiothoracic surgery; however, based on one prospective trial, this practice cannot be recommended routinely. The literature evaluating the effectiveness of local gentamicin use as sponges and collagen implants in cardiothoracic surgery has been inconsistent.…”

“…26,[33][34][35][36][37][38][39] Antibiotic ointments have been most studied in dermatologic procedures but have also been studied in cardiothoracic and orthopedic surgery. 31,[40][41][42][43][44][45] Although antibiotic ointments and pastes have been shown to be beneficial in contaminated and dirty wounds, their use for primary prophylaxis in clean surgical procedures is considered controversial. 46 Antibiotic-impregnated beads provide a steady release of antibiotic for up to 10 days after implantation and are useful in the treatment of established infections such as osteomyelitis.…”

“…The use of vancomycin paste was evaluated in 1989 in an RCT of patients undergoing cardiothoracic surgery. 43 This trial used 250 mg of vancomycin powder compounded with thrombin and gelatin to form a paste. The vancomycin paste was applied to the cut edges of the sternum in the treatment group.…”