Krzysztof Kępa1, Łukasz Krzych2, Michał Krejca3. 1. Department of Cardiac Surgery, Medical University of Silesia, Katowice-Ochojec, Poland. Electronic address: kepa.krzysiek@gmail.com. 2. Department of Cardiac Anesthesia and Intensive Care, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland. 3. Department of Cardiac Surgery, Medical University of Silesia, Katowice-Ochojec, Poland.
Abstract
INTRODUCTION: The majority of evidence for use of gentamicin-containing collagen implants (GCCI) demonstrates a positive impact on infection prophylaxis despite the equivocal results of a recently published large-scale study. The primary aim of the study was to evaluate the impact of prophylactic use of GCCI on SWI following cardiac surgery in a routine clinical setting. A secondary aim was to identify the risk factors for SWI among the patient cohort. METHODS: A consecutive series of patients who had undergone sternotomy were analysed on a retrospective basis. Patient characteristics, risk factors and procedure-related variables were analysed for Group I (superficial sternal wound infection [SSWI]) and Group II (deep sternal wound infection [DSWI]) in relation to patients with complete wound healing. RESULTS: A total of 1118 patients met the inclusion criteria. The bivariate analysis demonstrated that the SSWI rate was significantly reduced by 43% in the GCCI group vs. standard treatment. Multivariate analysis demonstrated that addition of GCCI to standard treatment reduced the DSWI rate by 59% vs. standard treatment alone. Arterial hypertension, permanent/persistent atrial fibrillation and chest revision were identified as new risk factors for SSWI and pulmonary hypertension and chest revision were identified as new risk factors for DSWI. DISCUSSION: This study confirms the positive results with GCCI seen in the majority of published studies in cardiac surgery. CONCLUSION: In routine clinical practice the addition of GCCI to standard infection prophylaxis reduces the risk of both SSWI and DSWI in high-risk patients undergoing cardiac surgery.
INTRODUCTION: The majority of evidence for use of gentamicin-containing collagen implants (GCCI) demonstrates a positive impact on infection prophylaxis despite the equivocal results of a recently published large-scale study. The primary aim of the study was to evaluate the impact of prophylactic use of GCCI on SWI following cardiac surgery in a routine clinical setting. A secondary aim was to identify the risk factors for SWI among the patient cohort. METHODS: A consecutive series of patients who had undergone sternotomy were analysed on a retrospective basis. Patient characteristics, risk factors and procedure-related variables were analysed for Group I (superficial sternal wound infection [SSWI]) and Group II (deep sternal wound infection [DSWI]) in relation to patients with complete wound healing. RESULTS: A total of 1118 patients met the inclusion criteria. The bivariate analysis demonstrated that the SSWI rate was significantly reduced by 43% in the GCCI group vs. standard treatment. Multivariate analysis demonstrated that addition of GCCI to standard treatment reduced the DSWI rate by 59% vs. standard treatment alone. Arterial hypertension, permanent/persistent atrial fibrillation and chest revision were identified as new risk factors for SSWI and pulmonary hypertension and chest revision were identified as new risk factors for DSWI. DISCUSSION: This study confirms the positive results with GCCI seen in the majority of published studies in cardiac surgery. CONCLUSION: In routine clinical practice the addition of GCCI to standard infection prophylaxis reduces the risk of both SSWI and DSWI in high-risk patients undergoing cardiac surgery.
Authors: M Rizwan Sohail; Zerelda Esquer Garrigos; Claude S Elayi; Kun Xiang; John N Catanzaro Journal: Pacing Clin Electrophysiol Date: 2020-03-05 Impact factor: 1.976