title: Treatment of gram-positive deep sternal wound infections in cardiac surgery--experiences with daptomycin.
abstract: The reported incidence of deep sternal wound infection (DSWI) after cardiac surgery is 0.4-5% with Staphylococcus aureus being the most common pathogen isolated from infected wound sternotomies and bacteraemic blood cultures. This infection is associated with a higher morbidity and mortality than other known aetiologies. Little is reported about the optimal antibiotic management. The aim of the study is to quantify the application of daptomycin treatment of DSWI due to gram-positive organisms post cardiac surgery. We performed an observational analysis in 23 cases of post sternotomy DSWI with gram-positive organisms February 2009 and September 2010. When the wound appeared viable and the microbiological cultures were negative, the technique of chest closure was individualised to the patient. The incidence of DSWI was 1.46%. The mean dose of daptomycin application was 4.4 ± 0.9 mg/kg/d and the average duration of the daptomycin application was 14.47 ± 7.33 days. In 89% of the patients VAC therapy was used. The duration from daptomycin application to sternal closure was 18 ± 13.9 days. The parameters of infection including, fibrinogen (p = 0.03), white blood cell count (p = 0.001) and C-reactive protein (p = 0.0001) were significantly reduced after daptomycin application. We had no mortality and wound healing was successfully achieved in all patients. Treatment of DSWI due to gram-positive organisms with a daptomycin-containing antibiotic regimen is safe, effective and promotes immediate improvement of local wound conditions.Based on these observations, daptomycin may offer a new treatment option for expediting surgical management of DSWI after cardiac surgery.
authors.affiliation: Department of Thoracic Cardiovascular Surgery, University of Göttingen, Germany. A.Popov@rbht.nhs.uk
authors.forename: Aron F
authors.initials: AF
authors.lastname: Popov
authors.forename: Jan D
authors.initials: JD
authors.lastname: Schmitto
authors.forename: Ahmad F
authors.initials: AF
authors.lastname: Jebran
authors.forename: Christian
authors.initials: C
authors.lastname: Bireta
authors.forename: Martin
authors.initials: M
authors.lastname: Friedrich
authors.forename: Direndra
authors.initials: D
authors.lastname: Rajaruthnam
authors.forename: Kasim O
authors.initials: KO
authors.lastname: Coskun
authors.forename: Anselm
authors.initials: A
authors.lastname: Braeuer
authors.forename: Jose
authors.initials: J
authors.lastname: Hinz
authors.forename: Theodor
authors.initials: T
authors.lastname: Tirilomis
authors.forename: Friedrich A
authors.initials: FA
authors.lastname: Schoendube
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D017576:Daptomycin / Q000627:therapeutic use*; D005260:Female; D005858:Germany / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D015994:Incidence; D008297:Male; D054843:Negative-Pressure Wound Therapy; D011446:Prospective Studies; D056346:Sternotomy; D013249:Sternum / Q000382:microbiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin