Should additional antibiotics or an iodine washout be given to all patients who suffer an emergency re-sternotomy on the cardiothoracic intensive care unit?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is beneficial to give additional antibiotics or an iodine washout after an emergency re-sternotomy on the intensive care unit. Using the reported search, 527 papers were identified. Nine papers represented the best evidence on the subject and the author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated. The quality and level of evidence was assessed using the International Liaison Committee on Resuscitation guideline recommendations. For patients who require an emergency re-sternotomy on the intensive care unit, the incidence of sternal wound infection or sepsis after this emergency treatment is around 5%. We found only seven papers that documented the incidence of infection after emergency re-sternotomy. Of these seven papers, five documented that they routinely gave additional intravenous antibiotics and a povodine-iodine washout. The other two papers did not report whether this was done. We conclude that even though the incidence of subsequent infection is low in the cardiac arrest situation, full aseptic technique including gown and gloves might be regarded as best practice. It is common practice also to give additional antibiotics and a povodine-iodine washout although we could identify no studies other than uncontrolled cohort studies in support of this.
Yap
ElaineYee Ling
EL
Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK.
Levine
Adrian
A
Strang
Tim
T
Dunning
Joel
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D019985:Benchmarking; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine; D006801:Humans; D007362:Intensive Care Units; D018579:Patient Selection; D011206:Povidone-Iodine / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012086:Reoperation; D018570:Risk Assessment; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods*
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine