title: Incidence of sternal wound infection after reexploration in the intensive care unit and the use of local gentamycin.
abstract: BACKGROUND
  Reoperation for bleeding is a known emergency complication after cardiac operations. When performed in the intensive care unit (ICU), sterility issues arise. Our aim was to examine the incidence of sternal wound infection (SWI) after reexploration in the ICU for bleeding with routine use of local gentamycin.
  
  
  METHODS
  From January 2003 until December 2009, 4,863 patients underwent cardiac operations through a median sternotomy at our institution. We conducted a retrospective database review identifying all patients who required reoperations. The occurrence of SWI in this group was compared with the general cardiac surgical population. Reoperations for bleeding during this period were conducted routinely in the ICU with prophylactic application of a gentamycin sponge between the sternal halves before closure in all cases.
  
  
  RESULTS
  Reexploration for bleeding was necessary in 302 patients (6.2%), and SWI occurred in 11, for a rate of 3.6%. SWI occurred in 174 of the 4,561 non-reexplored patients, for a similar rate of 3.8% (p>0.9). These values are similar to our overall rate of SWI of 3.8% (n=185) in the total cohort of 4,863 patients.
  
  
  CONCLUSIONS
  The incidence of SWI was not increased in our study group after emergency reoperation for bleeding in the ICU after the local use of gentamycin. Our data suggest that reexploration in an ICU setting for bleeding does not pose a sterility challenge and that life-threatening delays due to transfer to the operating theater may be avoided.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital of Zürich, Zürich, Switzerland. diana.reser@usz.ch
authors.forename: Diana
authors.initials: D
authors.lastname: Reser
authors.forename: Hector
authors.initials: H
authors.lastname: Rodriguez Cetina Biefer
authors.forename: André
authors.initials: A
authors.lastname: Plass
authors.forename: Christian
authors.initials: C
authors.lastname: Ruef
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettex
authors.forename: Patric
authors.initials: P
authors.lastname: Biaggi
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Sacha P
authors.initials: SP
authors.lastname: Salzberg
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects* / Q000379:methods; D015503:Surgical Sponges; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D013557:Switzerland / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins