O uso da vancomicina em pasta na hemostasia do esterno e profilaxia da mediastinite

Arruda, Marcus Vinícius Ferraz de; Braile, Domingo Marcolino; Joaquim, Marcos Rogério; Suzuki, F; Alves, Raquel Helena

doi:10.1590/s0102-76382008000100007

Cited by 32 publications

(6 citation statements)

References 17 publications

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“…In a case series of 532 low DSWI-risk patients undergoing coronary artery bypass grafting were subjected to several changes in clinical practice thought to reduce DSWI risk, along with use of vancomycin paste, and did not observe any DSWI (7). An additional case series of 1,020 patients, all receiving vancomycin paste, observed an incidence of DSWI of 0.45%, but failed to reference any control group (15). Comparison of our study with this prior literature reveals several factors that may cause these differences.…”

Section: Commentmentioning

confidence: 96%

Vancomycin Paste Does Not Reduce the Incidence of Deep Sternal Wound Infection After Cardiac Operations

Lander

Ejiofor

McGurk

et al. 2017

The Annals of Thoracic Surgery

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Background Deep sternal wound infection (DSWI) is a devastating complication that increases morbidity and mortality in cardiac surgery patients. Vancomycin is often administered intravenously for antibiotic prophylaxis in cardiac surgery. Many cardiac surgeons also apply vancomycin paste topically to the sternal edges. We examined the effect of vancomycin paste upon the incidence of DSWI in patients undergoing elective cardiac surgery. Methods We performed a single institution, retrospective medical record review of all patients from 2003 to 2015 who underwent CABG, valve or CABG/valve surgery. We derived the Society for Thoracic Surgeons (STS) DSWI risk index for each patient and performed a systematic review of operative, pharmacy, microbiology and discharge records to identify patients that developed DSWI. Multivariate analyses were used to identify predictors of DSWI in this cohort and to quantify the effect of vancomycin paste. Results 14,492 patients were examined, of whom 136 patients developed DSWI, resulting in an overall incidence of 0.9%. After multivariate analysis, body mass index, NYHA class and STS DSWI risk index remained statistically significant and associated with DSWI. Although the incidence of DSWI decreased over time, the use of vancomycin paste was not associated with a reduced incidence of DSWI. Conclusions There was a marked decrease in the incidence of DSWI over the study period, concurrent with institutional implementation of revised STS antibiotic dosing guidelines in 2007 and other strategies. However, the application of vancomycin paste to the sternal edges of patients undergoing cardiac surgery was not associated with a reduced risk of DSWI.

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Section: Commentmentioning

confidence: 96%

Vancomycin Paste Does Not Reduce the Incidence of Deep Sternal Wound Infection After Cardiac Operations

Lander

Ejiofor

McGurk

et al. 2017

The Annals of Thoracic Surgery

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“…Mediastinitis is a deep wound infection after median sternotomy, with clinical evidence and / or microbiological commitment of the retrosternal space, associated with sternal osteomyelitis with or without its instability [1][2][3][4]. It is one of the most serious complications of median sternotomy and is associated to significant morbidity and mortality [5].…”

Section: Introductionmentioning

confidence: 99%

Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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Background: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. Diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons.Objective SÁ, MPBO ET AL -Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patientsRev Bras Cir Cardiovasc 2011;26(2):183-9

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Section: Introductionmentioning

confidence: 99%

Artéria torácica interna esqueletizada está associada a menores taxas de mediastinite em idosos submetidos à cirurgia de revascularização miocárdica

Sá¹,

Santos²,

Figueiredo³

et al. 2011

Rev Bras Cir Cardiovasc

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Artéria torácica interna esqueletizada está associada a menores taxas de mediastinite em idosos submetidos à cirurgia de revascularização miocárdicaSkeletonized internal thoracic artery is associated with lower rates of mediastinitis in elderly undergoing coronary artery bypass grafting surgery Abstract Background and Objectives: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. The aim of this study is to identify which option of harvesting internal thoracic artery (ITA), pedicled or skeletonized, is associated with lower rates of mediastinitis after coronary artery bypass grafting surgery (CABG) in elderly, in the Division of Cardiovascular Surgery of PROCAPE.Methods: Retrospective study of 160 elderly who underwent consecutive CABG between May 2007 and June 2011. Eleven preoperative variables, four intraoperative variables and eight postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated between two groups: CABG with skeletonized ITA (n=80) and pedicled ITA (n=80). Univariate and multivariate logistic regression analyses were applied.Results: The incidence of mediastinitis was 6.8% (n=11), with a lethality rate of 54.5% (n=6). The skeletonized ITA group were more exposed than pedicled ITA group to obesity (n=12 vs. n=4; 15% vs. 5%; P=0.035) and multiple transfusions (n=25 vs. n=11; 31.2% vs. 13.7%; P=0.008). The pedicled ITA group presented a greater risk of mediastinitis after CABG than skeletonized ITA group (n=10 vs. n=1; 12.5% vs. 1.2%; Unadjusted OR 11.3; 95% CI 1.4 -241.5; P=0.008). In multivariate analysis, this difference maintained statistically significant (Adjusted OR 5.2; 95% CI 1.5-495.8; P=0.012), being considered an independent association.Conclusions: We suggest that elderly should be considered for strategies to minimize risk of infection. In elderly that undergo unilateral ITA, the problem seems to be related to how ITA is harvested. Elderly should always be considered for use of skeletonized ITA. 618Sá MPBO, et al. -Skeletonized internal thoracic artery is associated with lower rates of mediastinitis in elderly undergoing coronary artery bypass grafting surgery Bras Cir Cardiovasc 2011;26(4):617-23 Rev

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O uso da vancomicina em pasta na hemostasia do esterno e profilaxia da mediastinite

Cited by 32 publications

References 17 publications

Vancomycin Paste Does Not Reduce the Incidence of Deep Sternal Wound Infection After Cardiac Operations

Vancomycin Paste Does Not Reduce the Incidence of Deep Sternal Wound Infection After Cardiac Operations

Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients

Artéria torácica interna esqueletizada está associada a menores taxas de mediastinite em idosos submetidos à cirurgia de revascularização miocárdica

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