Prevention of wound infection in cardiac surgery: how much is topical use of antibiotics justified?

Bazylev V.V., Karpunkin O.A., Voevodin A.B., Medovshchikova S.E., Karnakhin V.A., Rosseikin E.V.

Federal Centre of Cardiovascular Surgery under the RF Public Health Ministry, Penza, Russia

The authors studied efficacy of preventing wound infection of a sternotomic wound with and without conventional use of topical antibiotics, also determining predictors of the development of infectious complications after cardiosurgical interventions.

Our retrospective study included a total of 1,593 patients subdivided into two groups. In Group One patients (n=951) sternal infection was prevented according to the P. Vogt technique; Group two patients (n=642) were also subjected to the same methodology, but with the exception of topical use of antibiotics.

By the frequency of re-sternotomies performed, cases of superficial and deep wound infection, as well as by the average duration of operation, hospital and ICU stay there were no statistically significant differences between the groups (p<0.05). The average cost of antibacterial agents as calculated per one patient in Group One turned out substantially higher than in Group Two (amounting to 8.1±3.9 and 3.3±1.4 thousand roubles, respectively, p<0.001). Analysing possible predictors of the risk for the development of wound infection showed that the body mass index, duration of the operation, and performing re-sternotomy exerted a statistically significant influence on probability of infections complications.

It was determined that using the methodology of preventing sternal infection with topical application of antibiotics led to predominance of Gram-negative flora in the wound discharge (p=0.02). Exclusion of topical use of antibiotics does not lead to an increase in the incidence rate of wound complications (p=0.78) and normalizes the ratio of Gram-negative and Gram-positive strains.

KEY WORDS: cardiac surgery, sternotomy, infectious complications, sternal infection, wound infection, antibiotics, topical treatment, predictors.

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