title: Gentamicin-collagen sponge reduces the risk of sternal wound infections after heart surgery: Meta-analysis.
abstract: OBJECTIVE
  Sternal wound infections are serious postoperative complications that increase the length of hospital stay and healthcare costs. The benefit of implantable gentamicin-collagen sponges in reducing sternal wound infections has been questioned in a recent multicenter trial. We aimed to perform a comprehensive meta-analysis of studies assessing the efficacy of implantable gentamicin-collagen sponges in sternal wound infection prevention.
  
  
  METHODS
  Multiple databases were screened for studies assessing the efficacy of implantable gentamicin-collagen sponges after heart surgery. The primary end point was sternal wound infection, and secondary end points were the occurrence of deep sternal wound infection, superficial sternal wound infection, mediastinitis, and mortality. Randomized controlled trials and observational studies were analyzed separately. By means of meta-regression, we examined the correlation between sternal wound infection and extent to which the bilateral internal thoracic artery was harvested.
  
  
  RESULTS
  A total of 14 studies (N = 22,135, among them 4 randomized controlled trials [N = 4672]) were included in the analysis. Implantable gentamicin-collagen sponges significantly reduced the risk of sternal wound infection by approximately 40% when compared with control (risk ratio [RR], 0.61; 95% confidence interval [CI], 0.39-0.98; P = .04 for randomized controlled trials and RR, 0.61; 95% CI, 0.42-0.89; P = .01 for observational studies). A similar, significant benefit was demonstrated for deep sternal wound infection (RR, 0.60; 95% CI, 0.42-0.88; P = .008) and superficial sternal wound infection (RR, 0.60; 95% CI, 0.43-0.83; P = .002). The overall analysis revealed a reduced risk of mediastinitis (RR, 0.64; 95% CI, 0.45-0.91; P = .01). The risk of death was unchanged. A significant positive linear correlation (P = .05) was found between the log RR of sternal wound infection and the percentage of patients receiving bilateral internal thoracic artery grafts.
  
  
  CONCLUSIONS
  Implantable gentamicin-collagen sponges significantly reduce the risk of sternal wound infection after cardiac surgery, with evidence consistent in randomized and observational-level data. However, the extent of this benefit might be attenuated in patients receiving bilateral internal thoracic artery grafts.
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland; Systematic Investigation and Research on Interventions and Outcomes, Medicine Research Network, Poland. Electronic address: kowalewkimariusz@gazeta.pl.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kowalewski
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland; Cardiac Surgery, Nicolaus Copernicus University in Toruń, Collegium Medicum, Bydgoszcz, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Pawliszak
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zaborowska
authors.affiliation: Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich-Heine-University, Düsseldorf, Germany; Systematic Investigation and Research on Interventions and Outcomes, Medicine Research Network, Poland.
authors.forename: Eliano Pio
authors.initials: EP
authors.lastname: Navarese
authors.affiliation: Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum, Bydgoszcz, Poland.
authors.forename: Krzysztof Aleksander
authors.initials: KA
authors.lastname: Szwed
authors.affiliation: Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland; Systematic Investigation and Research on Interventions and Outcomes, Medicine Research Network, Poland.
authors.forename: Magdalena Ewa
authors.initials: ME
authors.lastname: Kowalkowska
authors.affiliation: Lung Cancer and Thoracic Surgery Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kowalewski
authors.affiliation: Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum, Bydgoszcz, Poland.
authors.forename: Alina
authors.initials: A
authors.lastname: Borkowska
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland; Cardiac Surgery, Nicolaus Copernicus University in Toruń, Collegium Medicum, Bydgoszcz, Poland.
authors.forename: Lech
authors.initials: L
authors.lastname: Anisimowicz
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D004337:Drug Carriers; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects; D008480:Mediastinitis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D015503:Surgical Sponges; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004337:Drug Carriers; D005839:Gentamicins