DOI: http://dx.doi.org/10.18203/2349-2902.isj20220628

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

Soham J. Shah, Uday E. Jadhav

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.

 


Keywords


Mediastinitis, Topical Vancomycin, Sternotomy

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References


Toumpoulis IK, Anagnostopoulos CE, Derose JJ, Swistel DG. The impact of deep sternal wound infection on long-term survival after coronary artery bypass grafting. Chest. 2005;127:464-71.

Graf K, Ott E, Vonberg RP, Kuehn C, Haverich A, Chaberny IF. Economic as- pects of deep sternal wound infections. Eur J Cardiothorac Surg. 2010;37:893-6.

Braxton JH, Marrin CA, McGrath PD, Ross CS, Morton JR, Norotsky M, et al. Northern New England Cardiovascular Disease Study Group. Mediastinitis and long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg. 2000;70:2004-7.

Milano CA, Kesler K, Archibald N, Sexton DJ, Jones RH. Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival. Circulation. 1995;92:2245-51.

Edwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR. Society ofThoracic Surgeons. The Society of Thoracic Surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery. Part I: duration. Ann Thorac Surg. 2006;81:397-404.

Lazar HL,Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. 2004;109:1497-502.

Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart opera- tions. Ann Thorac Surg. 1997;63:356-61.

Nelson DR, Buxton TB, Luu QN, Rissing JP. The promotional effect of bone wax on experimental Staphylococcus aureus osteomyelitis. J Thorac Cardiovasc Surg. 1990;99:977-80.

Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Pro-calcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:426-35.

Pastene B, Cassir N, Tankel J, Einav S, Fournier P, Thomas P, et al. Mediastinitis in the intensive care unit patient: a narrative review. Clin Microbiol Infect J. 2020;26:26-34.

Lu J, Grayson A, Jhaa B, Srinivasana A, Fabri B. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardio-thoracic Surg. 2003; 23:943-9.

D’Souza S, Guhadasan R, Siner S, Paulus S, Thorburn K, Chesters C, et al. Procalcitonin and other common biomarkers do not reliably identify patients at risk for bacterial infection after congenital heart surgery. Pediatr Critic Care Med. 2013;20(3):243-51.

Vander STJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V, et al. Reduction of sternal infection by application of topical vancomycin. J Thorac Cardiovasc Surg. 1989;98:618-22.

Pastene B, Cassir N, Tankel J, Einav S, Fournier P, Thomas P, et al. Mediastinitis in the intensive care unit patient: a narrative review Clin Microbiol Infect J. 2020;26:26-34.

Sá MP, Figueira ES, Figueira ES, Santos CA, Figueiredo OJ, Lima RO, et al. Validation of Magedanz SCORE as a predictor of mediastinitis after coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc. 2011;26:386-92.

Vestergaard R, Søballe K, Hasenkam J, Stilling M. Sternal instability measured with radiostereometric analysis. A study ofmethod feasibility, accuracy and precision. J Cardiothorac Surg. 2018;13:41.

Jadhao M, Shah V, Raut C, Mishra P, Khandekar J, Surana K. Vancomycin local application, role in deep sternal. Interact Cardio Vascular Thoracic Surg. 2013;17:479-84.

Lazar H. Commentary: Compliance with the American Association for Thoracic Surgery guidelines will prevent sternal wound infections and minimize postoperative complications in cardiac surgery patients during the COVID-19 pandemic. J Thorac Cardiovasc Surg. 2020;160:44-8.