Topical rifampicin for prevention of deep sternal wound infections in patients undergoing coronary artery bypass grafting

Santo, Luca Salvatore De; Rubino, A; Torella, Michele; Feo, Marisa De; Galgano, Viviana; Guarente, Nicola; Mango, Emilio; Savarese, Leonardo; Iorio, Francesco; Zebele, Carlo

doi:10.1038/s41598-020-64310-y

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…177 Other agents worth additional study include polyhexanide and rifampicin in certain patient populations. 178,179 Control blood-glucose level during the immediate postoperative period for all patients. 94 (Quality of evidence: HIGH) Monitor and maintain postoperative blood-glucose level regardless of diabetes status. Maintain postoperative blood-glucose level between 110 and 150 mg/dL.…”

Section: Section 4: Recommended Strategies To Prevent Ssimentioning

confidence: 99%

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Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

Calderwood

Anderson

Bratzler

et al. 2023

Infect. Control Hosp. Epidemiol.

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and purpose The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

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Section: Section 4: Recommended Strategies To Prevent Ssimentioning

confidence: 99%

“…177 Other agents worth additional study include polyhexanide and rifampicin in certain patient populations. 178,179 …”

Section: Section 4: Recommended Strategies To Prevent Ssimentioning

confidence: 99%

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

Calderwood

Anderson

Bratzler

et al. 2023

Infect. Control Hosp. Epidemiol.

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“…In his study done retrospectively, De Santo et al concluded that patients receiving local rifampicin wash of the mediastinum and sternal edges showed significant reduction in the incidence of deep sternal wound infection (0.3% versus 2.1%, P = .0391). ICU stay, hospital stay, and operative mortality were similar between the groups [De Santo 2020].…”

Section: E602mentioning

confidence: 78%

Dual Topical Antibiotic Application Prior to Sternotomy Closure Reduces Sternal Wound Infection Rates: A Simple Solution to a Grave Morbidity

C-Th

Mourad

2021

HSF

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Background: A significant cohort of patients who undergo cardiac surgery suffer from diabetes and atherosclerosis. These patients have impaired tissue perfusion, hence a reduction in antibiotic concentration in the subcutaneous tissues at the side of the mammary artery harvesting. Topical application of gentamicin and vancomycin before wound closure broadens the antibiotic spectrum and reduces the incidence of deep sternal wound infection. In this article, we compare the use of single versus dual application of vancomycin and/or gentamicin in sternotomy wounds in a single tertiary center. Methods: An observational cohort analysis with three sequential patient groups (N = 2550) was performed at Ain Shams University Hospital in Cairo. A control group (N = 850), vancomycin only group (N = 850), and vancomycin plus gentamicin group (N = 850) were included in the study, during the three-year period from January 2017 to December 2019. Patients who had minimal access surgery were excluded from this study. The presence of an infected postoperative sternotomy wound was assessed in all patients. Results: The presence of an infected sternotomy wound (El Oakley class 2B) was present in 38 patients (4.5%) in the control group, in 19 patients (2.2%) in the vancomycin group, and in nine patients (1.1%) in the dual antibiotic group, respectively (P < .001). In contrast to the usual, we had a proliferous growth of gram-negative organisms 29 (3.4%) in the control group, 10 (1.2%) in the vancomycin group, and five (0.6%) in the dual antibiotic group, respectively (P < .001). Conclusion: Deep sternal wound infection is a major cause of post-cardiac surgery morbidity and prolonged hospital stay. Adding the simple step of topical application of vancomycin and gentamicin to the sternotomy wound at the end of the procedure appeared to significantly reduce deep wound infection rates.

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Does routine topical antimicrobial administration prevent sternal wound infection after cardiac surgery?

Magro

Sousa-Uva

2020

Interactive CardioVascular and Thoracic Surgery

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Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Does routine topical antimicrobial administration prevent sternal wound infection (SWI) after cardiac surgery? Altogether >238 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several different antimicrobial agents, dosages and application protocols were found in the literature. Regarding topical vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76% risk reduction in any SWI. Collagen-gentamicin sponge application was associated with a 38% risk reduction in SWI in another meta-analysis by Kowalewski et al., which included 4 randomized control trials and >23 000 patients. Lower evidence observational studies found benefit in the use of different regimes, including: combination of vancomycin paste and subcutaneous gentamycin; combined cefazoline and gentamicin spray; isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We conclude that, in light of the body of evidence available, topical antibiotic application prevents SWI, including both superficial and deep SWI. The strongest evidence, derived from 2 meta-analyses, is related to the use of gentamicin-collagen sponges and topical vancomycin. Heterogeneity throughout studies regarding antibiotic agents, dosages, application protocols and SWI definition makes providing general recommendations challenging.

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Topical rifampicin for prevention of deep sternal wound infections in patients undergoing coronary artery bypass grafting

Cited by 3 publications

References 24 publications

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

Dual Topical Antibiotic Application Prior to Sternotomy Closure Reduces Sternal Wound Infection Rates: A Simple Solution to a Grave Morbidity

Does routine topical antimicrobial administration prevent sternal wound infection after cardiac surgery?

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