Gentamicin-Impregnated Collagen Sponge: Effectiveness in Preventing Sternal Wound Infection in High-Risk Cardiac Surgery

Abstract

Sternal wound infections represent one of the most frequent complications after cardiac surgery and are associated with high postoperative mortality. Several preventive methods have been introduced, and recently, gentamicin-impregnated collagen sponges (GICSs) have shown a promising effect in reducing the incidence of this type of complications. Gentamicin is an aminoglycoside antibiotic that has been widely used to treat infections caused by multiresistant bacteria; despite its effectiveness, its systemic use carries a risk of toxicity. GICSs appear to overcome this side effect, topically delivering high antibiotic concentrations to the wound and thus reducing the toxic-related events. Although several retrospective analyses and randomized controlled trials have studied the use of GICSs in cardiac surgery, conclusions regarding their efficacy in preventing sternal wound infection are inconsistent. We have reviewed the current literature focusing on high-risk patients.

In vitro Antimicrobial Activity of Chlorquinaldol against Microorganisms Responsible for Skin and Soft Tissue Infections: Comparative Evaluation with Gentamicin and Fusidic Acid

“…Indeed, high percentages of gentamicin-resistance in staphylococci isolated from skin infections have been reported by other authors, and nosocomial outbreaks of gentamicin-resistant S. aureus associated with the use of topical gentamicin were described in the past (Bint et al, 1977 ; Wyatt et al, 1977 ; Graham et al, 1980 ; Moet et al, 2007 ; Iwaki et al, 2011 ; Caraciolo et al, 2012 ). Moreover, use of gentamicin impregnated collagen sponges has been recently associated to an increased probability of sternal wound infection after cardiac surgery caused by gentamicin-resistant bacteria (Rapetto et al, 2016 ). As shown by time-kill curves, chlorquinaldol was bactericidal also against E. faecalis and S. pyogenes , at concentration of 2 × MIC, while no bactericidal effects were observed against P. acnes .…”

Introductory Editorial: Drug-Eluting Stents or Drug-Eluting Grafts? Insights from Proteomic Analysis

“…In this issue, Dr Rapetto and colleagues extensively reviewed the role of gentamicin-impregnated collagen sponges (GICSs) in preventing sternal wound infection. The use of these delivery devices allows for topical delivery of high antibiotic concentrations to the wound, reducing the complications associated with gentamycin toxicity 4. On the other side, alternative use of smart biopolymers able to release anticoagulant agents, such as heparin, to avoid early vascular graft thrombosis and failure will be presented and discussed in the same issue of the Journal 5.…”

The efficacy of topical gentamycin application on prophylaxis and treatment of wound infection: A systematic review and meta‐analysis

“…Gentamycin is an amino‐glycoside antibiotic that has also been widely used to treat infections caused by multi‐resistant bacteria. Although its spectrum is mainly directed towards gram‐negative species, gentamycin is also effective against several gram‐positive strains . Furthermore, gentamycin also shows a synergy with beta‐lactam antibiotics, especially against gram‐positive species such as Staphylococcus aureus and CoNS .…”

“…Although its spectrum is mainly directed towards gram-negative species, gentamycin is also effective against several gram-positive strains. 11 Furthermore, gentamycin also shows a synergy with beta-lactam antibiotics, especially against gram-positive species such as Staphylococcus aureus and CoNS. 12 Nevertheless, the principal factor limiting its systemic use is represented by its intrinsic toxicity, when administered intravenously or intramuscularly, gentamycin accumulates into renal cortex and into endolymph and perilymph of the inner ear, causing kidney injury and hearing loss.…”