Collagen-gentamicin implant for prevention of sternal wound infection; long-term follow-up of effectiveness.
In a previous randomized controlled trial (LOGIP trial) the addition of local collagen-gentamicin reduced the incidence of postoperative sternal wound infections (SWI) compared with intravenous prophylaxis only. Consequently, the technique with local gentamicin was introduced in clinical routine at the two participating centers. The aim of the present study was to re-evaluate the technique regarding the prophylactic effect against SWI and to detect potential shifts in causative microbiological agents over time. All patients in this prospective two-center study received prophylaxis with application of two collagen-gentamicin sponges between the sternal halves in addition to routine intravenous antibiotics. All patients were followed for 60 days postoperatively. From January 2007 to May 2008, 1359 patients were included. The 60-day incidences of any SWI was 3.7% and of deep SWI 1.5% (1.0% mediastinitis). Both superficial and deep SWI were significantly reduced compared with the previous control group (OR=0.34 for deep SWI, P<0.001). There was no increase in the absolute incidence of aminoglycoside resistant agents. The majority of SWI were caused by coagulase-negative staphylococci (CoNS). The incidence of deep SWI caused by Staphylococcus aureus was 0.07%. The results indicate a maintained effect of the prophylaxis over time without absolute increase in aminoglycoside resistance. (ClinicalTrials.gov NCT00484055).
Friberg
Orjan
O
Department of Cardiothoracic Surgery and Anesthesiology, Orebro University Hospital, SE 70185 Orebro, Sweden.
Dahlin
Lars-Göran
LG
Källman
Jan
J
Kihlström
Erik
E
Söderquist
Bo
B
Svedjeholm
Rolf
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002626:Chemistry, Pharmaceutical; D003094:Collagen; D004337:Drug Carriers; D004343:Drug Implants; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000382:microbiology / Q000517:prevention & control*; D008875:Middle Aged; D010406:Penicillins / Q000008:administration & dosage; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013249:Sternum / Q000601:surgery*; D015503:Surgical Sponges; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D004337:Drug Carriers; D004343:Drug Implants; D005839:Gentamicins; D010406:Penicillins; D003094:Collagen