title: The effect of topical vancomycin applied to sternotomy incisions on postoperative serum vancomycin levels.
abstract: OBJECTIVE
  Topical vancomycin has been shown to reduce the incidence of sternal wound infections but concerns have been raised that persistent serum levels of vancomycin may contribute to the emergence of drug-resistant infections. This study was undertaken to determine: (1) whether serum levels of vancomycin remain elevated when applied topically to the sternum and (2) whether the use of topical vancomycin can potentiate postoperative drug-resistant infections.
  
  
  METHODS
  Serum vancomycin levels were measured on the evening of surgery and the sixth postoperative day in 36 patients in which topical vancomycin was applied to the cut edges of the sternum during their cardiac surgical procedures. Data are presented as a mean ± standard deviation and statistical significance was tested using paired t-test analyses.
  
  
  RESULTS
  There was a significant decrease in serum vancomycin levels from the night of surgery to the sixth postoperative day (11.5 ± 1.9 μg/mL to 2.12 ± 0.79 μg/mL; p <0.0001). The incidence of sternal infections was 0% and no patient developed any infection or had renal toxicity during the 12-month follow-up.
  
  
  CONCLUSIONS
  The use of topical vancomycin applied to the sternotomy incision does not result in persistently elevated levels of serum vancomycin following cardiac surgical procedures. Furthermore, topical vancomycin does not potentiate the emergence of drug-resistant infections or contribute to postoperative renal toxicity.
authors.affiliation: Department of Cardiothoracic Surgery, Boston Medical Center, Boston, Massachusetts 02118, USA. harold.lazar@bmc.org
authors.forename: Harold L
authors.initials: HL
authors.lastname: Lazar
authors.forename: Tamar
authors.initials: T
authors.lastname: Barlam
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
mesh_terms: D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D006348:Cardiac Surgical Procedures / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000097:blood / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015995:Prevalence; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013530:Surgical Wound Infection / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin