Does locally administered gentamicin affect the incidence of sternal wound infections after coronary artery bypass graft surgery?

Balkanay, Ozan Onur; Göksedef, Deniz; Göde, Safa; Kılıç, Zeynep; İpek, Gökhan

doi:10.5606/tgkdc.dergisi.2015.10246

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…Studies were predominantly at a low-to-moderate risk of bias. The median follow-up was three months and ranged from one month 19 , 20 , 22 , 25 to one year 5 , 18 . Studies analyzed topical vancomycin vs control (2,187 patients) 5 , 15 – 20 and topical gentamicin vs control (5,532 patients) 21 – 26 as SWI prophylaxis.…”

Section: Resultsmentioning

confidence: 99%

“…Among vancomycin-based RAD four studies used paste 15 , 16 , 19 , 20 , one, vancomycin powder 17 , one, vancomycin solution 18 , and one used a sponge soaked in vancomycin 5 . All gentamicin studies evaluated gentamicin-collagen implants 23 or sponges 21 , 22 , 24 – 26 (Supplementary Table 5). Intra-venous antibiotic prophylaxis consistent mostly of second-or third -generation cephalosporins; one study reported routine iv.…”

Section: Resultsmentioning

confidence: 99%

“…cefepime prophylaxis. Six studies reported on the protocol mandated blood glucose levels control 17 – 19 , 21 , 22 , 26 (Supplementary Table 5).…”

Section: Resultsmentioning

confidence: 99%

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Regional antibiotic delivery for sternal wound infection prophylaxis a systematic review and meta-analysis of randomized controlled trials

Kowalewski,

Kołodziejczak,

Urbanowicz

et al. 2024

Sci Rep

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Despite evidence suggesting the benefit of prophylactic regional antibiotic delivery (RAD) to sternal edges during cardiac surgery, it is seldom performed in clinical practice. The value of topical vancomycin and gentamicin for sternal wound infections (SWI) prophylaxis was further questioned by recent studies including randomized controlled trials (RCTs). The aim of this systematic review and meta-analysis was to comprehensively assess the safety and effectiveness of RAD to reduce the risk of SWI.We screened multiple databases for RCTs assessing the effectiveness of RAD (vancomycin, gentamicin) in SWI prophylaxis. Random effects meta-analysis was performed. The primary endpoint was any SWI; other wound complications were also analysed. Odds Ratios served as the primary statistical analyses. Trial sequential analysis (TSA) was performed.Thirteen RCTs (N = 7,719 patients) were included. The odds of any SWI were significantly reduced by over 50% with any RAD: OR (95%CIs): 0.49 (0.35–0.68); p < 0.001 and consistently reduced in vancomycin (0.34 [0.18–0.64]; p < 0.001) and gentamicin (0.58 [0.39–0.86]; p = 0.007) groups (psubgroup = 0.15). Similarly, RAD reduced the odds of SWI in diabetic and non-diabetic patients (0.46 [0.32–0.65]; p < 0.001 and 0.60 [0.44–0.83]; p = 0.002 respectively). Cumulative Z-curve passed the TSA-adjusted boundary for SWIs suggesting adequate power has been met and no further trials are needed. RAD significantly reduced deep (0.60 [0.43–0.83]; p = 0.003) and superficial SWIs (0.54 [0.32–0.91]; p = 0.02). No differences were seen in mediastinitis and mortality, however, limited number of studies assessed these endpoints. There was no evidence of systemic toxicity, sternal dehiscence and resistant strains emergence. Both vancomycin and gentamicin reduced the odds of cultures outside their respective serum concentrations’ activity: vancomycin against gram-negative strains: 0.20 (0.01–4.18) and gentamicin against gram-positive strains: 0.42 (0.28–0.62); P < 0.001. Regional antibiotic delivery is safe and effectively reduces the risk of SWI in cardiac surgery patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Regional antibiotic delivery for sternal wound infection prophylaxis a systematic review and meta-analysis of randomized controlled trials

Kowalewski,

Kołodziejczak,

Urbanowicz

et al. 2024

Sci Rep

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“…Karabay et al [28] demonstrated an increased rate of superficial sternal wound infections, when the intracutaneous suture technique was used compared to the transcutaneous method. Balkanay et al [29] reported that using gentamicin-soaked sponges during CABG could decrease sternal wound infections.…”

Section: Discussionmentioning

confidence: 99%

Does using Jackson-Pratt drain affect the incidence of sternal wound complications after open cardiac surgery?

Salihi

2019

Turk Gogus Kalp Dama

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Bu çalışmada median sternotomi ile açık kalp cerrahisi yapılan, Vücut Kütle İndeksi ≥30 kg/m 2 olan hastalarda Jackson-Pratt dreninin sternal yara komplikasyonları üzerindeki etkisi incelendi. Ça lış mapla nı:Ocak 2011-Aralık 2015 tarihleri arasında Vücut Kütle İndeksi ≥30 kg/m 2 olan, hastanemizde median sternotomi ile açık kalp cerrahisi yapılan toplam 174 hasta (124 erkek, 50 kadın; ort. yaş 58.2±10.4 yıl; dağılım, 33-78 yıl) retrospektif olarak incelendi. Hastaların 94'üne median sternotomi sonrası Jackson-Pratt dreni takılırken (JP grubu), 80 hastaya dren takılmadı (JP olmayan grup). Her iki grubun ameliyat tipi, hastanede kalış süresi ve komplikasyonlar dahil olmak üzere ameliyat öncesi, sırası ve sonrası sonuçları karşılaştırıldı. Bul gu lar: Gruplar arasında yaş, cinsiyet, Vücut Kütle İndeksi ve muhtemel risk faktörleri arasında anlamlı bir fark yoktu. Her iki grupta da yoğun bakım ünitesinde median kalış süresi iki gün ve ameliyattan taburculuğa kadar geçen median süre yedi gündü. Gruplar arasında sternal yara komplikasyon oranı açısından istatistiksel olarak anlamlı bir fark bulundu. Dren takılmayan grupta dokuz hastaya (%11.25) kıyasla, dren takılan grupta iki hastada (%2.1) sternal yara komplikasyonu gelişti (p= 0.01). So nuç: Çalışma bulgularımız, median sternotomi sonrasında Jackson-Pratt dren kullanımının vücut kitle indeksi ≥30 kg/m 2 olan, açık kalp cerrahisi yapılan hastalarda geleneksel kapatma tekniğine kıyasla, ameliyat sonrası sternal yara komplikasyon riskini azaltmada basit ve güvenli bir yöntem olduğunu göstermektedir. Anah tar söz cük ler: Jackson-Pratt dreni; median sternotomi; sternal yara komplikasyonları.

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“…They also noted a greater decrease in the rates of SSWI than in deep infections. In 2015, Balkanay et al described another method of delivering local gentamicin locally at the surgical wound site [14]. In their study, they treated surgical sponges by placing them in a normal saline solution in which gentamicin was dissolved.…”

Section: Discussionmentioning

confidence: 99%

The role of topical Genta Fleece HD and gentamicin spray in prevention of sternum wound infections after open heart surgery: a comparative study

Şahın¹

2018

Arch Med Sci Atheroscler Dis

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IntroductionThe aim was to clarify and compare the efficacy of local Genta Fleece HD (GF) and topical gentamicin spray (GS) in prevention of wound infections by comparing their results with a control group.Material and methodsIn this retrospective study, charts of patients who underwent coronary artery bypass grafting in a tertiary academic center between January 2015 and January 2017 were analyzed. Patients were divided into three groups: patients in whom GF was applied, patients in whom GS was applied, and a control group in which no additional material was applied. All patients received intravenous antibiotic prophylaxis. Deep and superficial sternal wound infections (SWIs) during the postoperative period were analyzed.ResultsThe overall infection rate was 13.8% (n = 51). Patients in whom GF was applied had significantly fewer SWIs when compared to the GS group and control group (p = 0.002). A significantly smaller number of deep SWIs occurred in the GS group (7/177; 3.9%) than in the control group (14/125; 11.2%). The superficial SWI rate was significantly lower (2/79; 2.5%) in the GF group than in the other two groups. Duration of hospital stay was significantly shorter in the GF group, followed by the GS and control groups. High EuroSCORE results (≥ 4), obesity (BMI > 30 kg/m2), performing the operations under emergency situations and presence of chronic obstructive pulmonary disease were identified as significant risk factors in the development of SWI.ConclusionsLocal GS reduced deep SWIs, whereas GF implantation reduced the overall and superficial SWIs. Also, GF application was superior in terms of reducing the duration of hospital stay.

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Does locally administered gentamicin affect the incidence of sternal wound infections after coronary artery bypass graft surgery?

Cited by 3 publications

References 15 publications

Regional antibiotic delivery for sternal wound infection prophylaxis a systematic review and meta-analysis of randomized controlled trials

Regional antibiotic delivery for sternal wound infection prophylaxis a systematic review and meta-analysis of randomized controlled trials

Does using Jackson-Pratt drain affect the incidence of sternal wound complications after open cardiac surgery?

The role of topical Genta Fleece HD and gentamicin spray in prevention of sternum wound infections after open heart surgery: a comparative study

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