Local application of gentamicin-containing collagen implant in the prophylaxis and treatment of surgical site infection following cardiac surgery.
BACKGROUND
For the cardiac surgeon and patient the development of sternal wound infection is a serious post-operative complication associated with increased risk of death and also considerable morbidity.


METHODS
Nine publications were identified using the PubMed online database and search terms 'gentamicin-containing collagen implant' plus 'surgical site infection', 'wound infection' and 'cardiac surgery'.


RESULTS
Six out of eight studies demonstrated that prophylactic use of gentamicin-containing collagen implants (GCCI) significantly reduce the wound infection rate following cardiac surgery (via sternotomy) compared to standard treatment alone. The adjunctive use of GCCI is particularly beneficial in high-risk subjects e.g. diabetes and obese patients. GCCI significantly improve the morbidity associated with SSI following cardiac surgery by shortening the recovery phase and length of hospital stay; reducing the need for surgical revision and use of antibiotics. GCCI have been shown to be cost saving across a wide spectrum of patients. A further study has shown that GCCI may also have a therapeutic role to play in patients with deep sternal wounds.


CONCLUSIONS
This review demonstrates that when used dry prior to insertion GCCI can be effective in reducing the rate of SSI following cardiac surgery. GCCI have also been shown to be cost saving as they reduce the substantial morbidity associated with deep SSI. The adjunctive use of GCCI is particularly beneficial in high-risk patients. GCCI may also have a role to play in the treatment of deep sternal wound infection.
Department of Cardiac Surgery, Harefield Hospital, London UB9 6JH, United Kingdom. drrajashahzad@hotmail.com
Shahzad G
SG
Raja
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D024042:Collagen Type I / Q000008:administration & dosage*; D004343:Drug Implants; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*
D000900:Anti-Bacterial Agents; D024042:Collagen Type I; D004343:Drug Implants; D005839:Gentamicins