Collagen-gentamicin implant for prevention of sternal wound infection; long-term follow-up of effectiveness

Friberg, Örjan; Dahlin, Lars-Göran; Källman, Jan; Kihlström, Erik; Söderquist, Bo; Svedjeholm, Rolf

doi:10.1510/icvts.2009.207514

Cited by 46 publications

(56 citation statements)

References 12 publications

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“…In high-risk patients with osteoporotic bone, or in cases of non-midline sternotomy, we use parasternal wires in combination with the figure-of-8 wire technique and GMCS implantation. Friberg et al concluded that antibiotic prophylaxis with local GMCS was associated with a significant reduction in superficial and deep sternal wound infection [6]. Based on the results of their first randomized trial, local application of GMCS between the sternal halves was associated with a 53% relative reduction (4.7% absolute reduction) in the incidence of sternal wound infection after sternotomy in an unselected cardiac surgery patient population [5].…”

Section: Discussionmentioning

confidence: 99%

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Use of gentamicin-collagen sponges prior to sternal closure may lower the risk of sternal wound infection: a single center experience

Čanádyová¹,

Kurfirst²,

Mokrácek³

2012

kitp

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Despite improvements in prophylactic strategies, sternal wound infection following cardiac surgery still remains a significant complication, associated with prolonged hospitalization, high costs, patient discomfort and significant mortality. The aim of this study was to evaluate whether the local application of collagen-gentamicin sponges (GMCS) placed between the sternal halves before closure may decrease the incidence of median sternotomy wound infection. Between April 2008 and December 2009, 236 patients were enrolled in the study. We compared 120 consecutive patients whose wounds were closed with the use of collagen-gentamicin sponges (GMCS group) with 116 consecutive patients whose wounds were closed without the use of local antibiotic prophylaxis (non-GMCS group). All postoperative sternal wound complications were referred back to the Cardiac Surgery Department. The three-month incidence of any wound healing complication was the main outcome criterion. The use of GMCS significantly reduced the rate of wound infection to 8.3% vs. 19.8% in the non-GMCS group (p < 0.0197). The patients whose wounds were closed without the use of local antibiotic prophylaxis had a higher risk of infection-related complications compared with patients in whom GMCS were used prior to closure (OR = 2.95, 95% CI: 1.29-6.71). Our study demonstrated the benefit of using GMC in reducing the rate of sternal wound infection. Key words: cardiac surgery, surgical wound infection, gentamicin-collagen. StreszczenieMimo rozwoju strategii profilaktycznych, infekcja rany mostka po operacji kardiochirurgicznej wciąż pozostaje znaczącą komplikacją związaną z długą hospitalizacją, wysokimi kosztami, dyskomfortem pacjenta i znaczącą śmiertelnością. Celem niniejszej pracy była ocena, czy miejscowe stosowanie gąbek kolagenowych z gentamycyną (GMCS), umiejscawianych pomiędzy połowami mostka przed zamknięciem, może zmniejszyć występowanie infekcji rany po przecięciu mostka. Pomiędzy kwietniem 2008 r. a grudniem 2009 r. badanie objęło 236 pacjentów. Porównano 120 kolejnych pacjentów, u których rany zamknięto za pomocą gąbek kolagenowych z gentamycyną (grupa GMCS), ze 116 kolejnymi pacjentami, których rany zamknięto bez użycia miejscowej profilaktyki antybiotykowej (grupa non-GMCS). Wszystkich pacjentów z pooperacyjnymi komplikacjami rany mostka przekazano z powrotem do Katedry Kardiochirurgii. Wystąpienie jakiejkolwiek komplikacji gojenia się rany w ciągu 3 miesięcy było głównym kryterium wyniku. Użycie GMCS znacząco zmniejszyło współczynnik infekcji ran do 8,3%, w porównaniu z 19,8% w grupie non-GMCS (p < 0,0197). Pacjenci, u których rany zamknięto bez użycia miejscowej profilaktyki antybiotykowej, byli bardziej narażeni na komplikacje infekcyjne w porównaniu z pacjentami, u których przed zamknięciem użyto GMCS (OR = 2,95, 95% CI: 1,29-6,71). W niniejszej pracy wykazano korzyści płynące z używania GMC w celu zmniejszenia występowania infekcji ran mostka. Słowa kluczowe: kardiochirurgia, infekcja rany operacyjnej, kolagen z gentamycyną.Use of g...

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Section: Discussionmentioning

confidence: 99%

“…Classification of postoperative wound infection was made on the basis of the modified CDC classification described in the work of Friberg [5,6]. Superficial infections were defined as infections involving skin or subcutaneous tissue.…”

Section: From April 2008 To December 2009mentioning

confidence: 99%

Use of gentamicin-collagen sponges prior to sternal closure may lower the risk of sternal wound infection: a single center experience

Čanádyová¹,

Kurfirst²,

Mokrácek³

2012

kitp

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“…Collagen has various medical applications due to its biocompatibility, processability, mechanical strength, and enzymatic degradability by collagenases and metalloproteinases [303]. In fact, it is used as suture material in surgery [304], as depot delivery device in the local extended release of antibiotics [305], DNA [306], siRNA [307], and proteins [308] and as haemostatic sealant [309]. In tissue engineering, collagen sponges are widely diffused due to their ability to withstand high tensile loads (92.5 MPa ultimate tensile strength) [310].…”

Section: Proteins and Poly(amino Acids)mentioning

confidence: 99%

Biodegradable polymers for dental tissue engineering and regeneration

Conte¹,

Riccitiello²,

Luise³

et al. 2017

Biodegradable Polymers: Recent Developments and New Perspectives

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“…При локальном (местном) применение антибиотиков чаще всего применяют ванкомицин и гентамицин [12,24,27]. Несколько рандомизированных и обсер-вационных исследований продемонстрировали вы-сокую эффективность этого метода [10, 13,14,26].…”

Section: вве дениеunclassified

Choise of local antibacterial medications for prevention of sternal infection

et al. 2017

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Infection of wounds in surgery is one of the most frequent complications in the postoperative period. The development of this complication increases the duration of hospitalization, resulting in higher treatment costs, as well as the impact to the level of hospital mortality. There are many methods are exist to avoid this complication, which are allow to decontamination of pathogenic and conditionally pathogenic microorganisms including applying antimicrobial agents prior to surgery. One such method is intravenous antibiotic shortly before surgery. But there is evidence in the literature of successful local antibiotics in neurosurgery, traumatology and orthopedics, operations on the thorax and abdominal organs, including for prevention of sternal infection. For this purpose most often used vancomycin and gentamicin. This is often a causative agent of wound infection, which is a gram-positive flora: Staphylococcus aureus and Staphylococcus epidermidis. To increase the effectiveness of preventive measures to reduce the incidence of sternal infection intraoperatively topically applied antibiotics in various forms when closing the wound. For parenteral administration of antibiotics effective therapeutic dose is often not achieved, because it depend on the time period since the introduction of the substance until the start of the operation [3]. Local application of antibiotics to a reduction of frequency wound infection, as concentration of a substance is directly dependent on the applied dose.

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Collagen-gentamicin implant for prevention of sternal wound infection; long-term follow-up of effectiveness

Cited by 46 publications

References 12 publications

Use of gentamicin-collagen sponges prior to sternal closure may lower the risk of sternal wound infection: a single center experience

Use of gentamicin-collagen sponges prior to sternal closure may lower the risk of sternal wound infection: a single center experience

Biodegradable polymers for dental tissue engineering and regeneration

Choise of local antibacterial medications for prevention of sternal infection

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