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General Thoracic and Cardiovascular Surgery

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01-04-2016 | Original Article

Topical spraying of cefazolin and gentamicin reduces deep sternal wound infections after heart surgery: a multicenter, large volume, retrospective study

Authors: Hiroshi Osawa, Shinpei Yoshii, Samuel J. K. Abraham, Yuki Okamoto, Shigeru Hosaka, Shoji Fukuda, Koji Tsuchiya, Masato Nakajima, Yoshihiro Honda, Kouki Takizawa

Published in: General Thoracic and Cardiovascular Surgery | Issue 4/2016

Abstract

Objective

The use of topical antimicrobials applied to the sternum during cardiac procedures in combination with intravenous agents to prevent mediastinitis has been reported to yield good results. The objective of this study is to provide optimal method of topical antimicrobials for the prevention of sternal wound infection after cardiac surgery.

Methods

We retrospectively evaluated the patients undergoing adult cardiac surgery at five institutions between January 1994 and August 2013 for the incidence of deep sternal wound infection (DSWI). The patients were sprayed with a solution of cefazolin and gentamicin into the surgical site several times during surgery. The incidence of DSWI was evaluated. Four major risk factors [diabetes mellitus (DM), emergency operation, dialysis and prolonged operation] were also evaluated for their implications in the outcome with the antimicrobial spraying.

Results

Totally, 6960 patients were analyzed. The incidence of DSWI was 0.46 % in the spraying group versus 1.7 % in control group (p < 0.0001). There is no significant difference of the incidence of DSWI between DM and non-DM groups (p = 1.00), emergency and elective operation groups (p = 0.25) under usage of antimicrobial spraying. However, there is significant difference of the incidence of DSWI between dialysis and non-dialysis groups (p = 0.0222), longer than six-hour duration and lesser than six-hour duration operation groups (p = 0.0269).

Conclusion

Topical spraying of cefazolin and gentamicin reduces deep sternal wound infections after cardiac surgery. DM and emergency operation were not the risk factors of DSWI when antimicrobial spraying is administered. Considering the benefits, antimicrobial spraying could be used intermittently during such procedures.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247–78.CrossRef

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70:195–283.CrossRefPubMed

Alexander JW, Solomkin JS, Edwards MJ. Updated recommendations for control of surgical site infections. Ann Surg. 2011;253(6):1082–93.CrossRefPubMed

Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F, et al. The society of thoracic surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery, Part II: Atibiotic choice. Ann Thorac Surg. 2007;83:1569–76.CrossRefPubMed

Yoshii S, Hosaka S, Suzuki S, Takahashi W, Okuwaki H, Osawa H, et al. Prevention of surgical site infection by antibiotic spraying in the operative field during cardiac surgery. Jpn J Thorac Surg. 2001;49:279–81.

Shimmer C, Oezkur M, Shinha B, Hain J, Groski A, Hager B, et al. Gentamicin-collagen sponge reduces sternal wound complications after heart surgery: a controlled, prospectively randomized, double-blind study. J Thorac Cardiovasc Surg. 2012;143:194–200.CrossRef

Vander Salm TJ, 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.PubMed

Lazar HL, Barlam T, Cabral H. The effect of topical vancomicin applied tu sternotomy incisions on postoperative serum vancomicin levels. J Card Surg. 2011;26:461–5.CrossRefPubMed

Friberg O, Svedjeholm R, Soderquist B, Granfeldt H, Vikerfors T, Kallman J. Local gentamicin reduces sternal wound infections after cardiac surgery: a randomized cantrolled trial. Ann Thorac Surg. 2005;79:153–62.CrossRefPubMed

10.

Eklund AM, Valtonen M, Werkkala KA. Prophylaxis of sternal wound infections with gentamicin-collagen implant: randomized controlled study in cardiac surgery. J Hosp Infect. 2005;59:108–12.CrossRefPubMed

11.

Bennett-Guerrero E, Ferguson TB Jr, Lin M, Garg J, Mark DB, Scavo VA, et al. Effect of an implantable gentamicin-collagen sponge on sternal wound infections following cardiac surgery. JAMA. 2010;304:755–62.CrossRefPubMed

12.

Mavros MN, Mitsikostas PK, Alexiou VG, Peppas G, Falagas ME. Gentamicin collagen sponges for prevention of sternal wound infection: a meta-analysis of randomized controlled trials. J Thorac Cardiovasc Surg. 2012;144:1235–40.CrossRefPubMed

13.

Desmond J, Lovering A, Harle C, Djorevic T, Millner R. Topical vancomycin applied on closure of the sternotomy wound does not prevent high levels of systemic vancomycin. Eur J Cardiothorac Surg. 2003;23:765–70.CrossRefPubMed

14.

El Oakley RM, Nimer KA, Bukhari E. Is the use of topical vancomycin to predict mediastinitis after cardiac surgery justified? J Thorac Cardiovasc Surg. 2000;119:190–1.CrossRefPubMed

15.

Ferguson TB Jr, Dziuban SW Jr, Edwards FH, Eiken MC, Shroyer ALW, Pairolero PC, et al. The STS National Database: current changes and challenges for the new millennium. Committee to Establish a National Database in Cardiothoracic Surgery, The Society of Thoracic Surgeons. Ann Thorac Surg. 2000;69:680–91.CrossRefPubMed

16.

Filardo G, Hamilton C, Grayburn PA, Xu H, Hebeler RF, Hamman B. Established preoperative risk factors do not predict long-term survival in isolated coronary artery bypass grafting patients. Ann Thorac Surg. 2012;93:1943–9.CrossRefPubMed

17.

Kubota H, Miyata H, Motomura N, Ono M, Takamoto S, Harii K, et al. Deep sternal wound infection after cardiac surgery. J Cardiothorac Surg. 2013;8:132.CrossRefPubMedPubMedCentral

18.

El Oakley RM, Wright JE. Postoperative mediastinitis: classification and manegement. Ann Thorac Surg. 1996;61:1030–6.CrossRefPubMed

19.

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

20.

Shinagawa N. Antimicrobial prophylaxis in surgery. Jpn J Antibiot. 2004;57:11–32.PubMed

21.

Osawa H, Orii K. Will local use of antibiotics be essential? J Thorac Cardiovasc Surg. 2012;144:742.CrossRefPubMed

22.

Shimmer C, Leyh R. Reply to the Editor. J Thorac Cardiovasc Surg. 2012;144:742–3.CrossRef

23.

Minakata Kenji, Sakata Ryuzo. Perionerative control of blood glucose level in cardiac surgery. Gen Thorac Cardiovasc Surg. 2013;61:61–6.CrossRefPubMed

Title: Topical spraying of cefazolin and gentamicin reduces deep sternal wound infections after heart surgery: a multicenter, large volume, retrospective study
Authors: Hiroshi Osawa
Shinpei Yoshii
Samuel J. K. Abraham
Yuki Okamoto
Shigeru Hosaka
Shoji Fukuda
Koji Tsuchiya
Masato Nakajima
Yoshihiro Honda
Kouki Takizawa
Publication date: 01-04-2016
Publisher: Springer Japan
Published in: General Thoracic and Cardiovascular Surgery / Issue 4/2016
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-015-0615-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Topical spraying of cefazolin and gentamicin reduces deep sternal wound infections after heart surgery: a multicenter, large volume, retrospective study

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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