title: Topical vancomycin in combination with perioperative antibiotics and tight glycemic control helps to eliminate sternal wound infections.
abstract: OBJECTIVE
  This study was undertaken to determine whether topical vancomycin would further reduce the incidence of sternal infections in the presence of perioperative antibiotics and tight glycemic control.
  
  
  METHODS
  A total of 1075 consecutive patients undergoing cardiac surgery from December 2007 to August 2013 receiving topical vancomycin (2.5 g in 2 mL of normal saline) applied as a slurry to the cut edges of the sternum were compared with 2190 patients from December 2003 to November 2007 who did not receive topical vancomycin. All patients received perioperative antibiotics (cefazolin 2 g intravenously every 8 hours and vancomycin 1 g intravenously every 12 hours) on induction of anesthetic and continuing for 48 hours; and intravenous insulin infusions to maintain serum blood glucose level between 120 and 180 mg/dL.
  
  
  RESULTS
  Patients receiving topical vancomycin had less superficial sternal infections (0% vs 1.6%; P < .0001), deep sternal infections (0% vs 0.7%; P = .005), any type of sternal infection (0% vs 2.2%; P < .0001) and significantly less sternal infections of any type in patients with diabetes mellitus (0% vs 3.3%; P = .0004).
  
  
  CONCLUSIONS
  Topical vancomycin applied to the sternal edges, in conjunction with perioperative antibiotics and tight glycemic control, helps to eliminate wound infections in cardiac surgical patients.
authors.affiliation: Division of Cardiac Surgery, Boston Medical Center and the Boston University School of Medicine, Boston, Mass. Electronic address: harold.lazar@bmc.org.
authors.forename: Harold L
authors.initials: HL
authors.lastname: Lazar
authors.affiliation: Division of Cardiac Surgery, Boston Medical Center and the Boston University School of Medicine, Boston, Mass.
authors.forename: Ara
authors.initials: A
authors.lastname: Ketchedjian
authors.affiliation: Division of Cardiac Surgery, Boston Medical Center and the Boston University School of Medicine, Boston, Mass.
authors.forename: Miguel
authors.initials: M
authors.lastname: Haime
authors.affiliation: Division of Cardiac Surgery, Boston Medical Center and the Boston University School of Medicine, Boston, Mass.
authors.forename: Karl
authors.initials: K
authors.lastname: Karlson
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Mass.
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002437:Cefazolin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000097:blood / Q000382:microbiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D014640:Vancomycin; D002437:Cefazolin