Role of topical application of gentamicin containing collagen implants in cardiac surgery

Abstract

Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration. There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be effective against bacteria that are considered resistant to gentamycin and other antibiotics.However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of antimicrobial resistance.We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness. They should be used in dry condition and should not be soaked in saline even for a short period prior to use. However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be sufficiently powered to address this issue, multicenter studies might be the way forward.Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection.

Vancomycin-releasing cross-linked collagen sponges as wound dressings

“…To date, the application of vancomycin-releasing collagen sponges as wound dressings has not been studied to any significant extent. Current approaches involve either the incorporation of other antibiotics into collagen sponges [1][2][3] or the use of vancomycin as one element of hydroxyapatite beads in the treatment of musculoskeletal injuries [4,5]. Moreover, various studies have described the administration of a vancomycin powder directly on surgical wounds so as to prevent wound infection following spinal, cardiac, or vascular surgery, with good effects [6,7].…”

Antibacterial-Integrated Collagen Wound Dressing for Diabetes-Related Foot Ulcers: An Evidence-Based Review of Clinical Studies

“…Gentamicin is an antibiotic from the aminoglycoside class that is active against many strains of Gram-positive and Gram-negative pathogens [ 59 ]. As an aminoglycoside, gentamicin has shown a rapid bactericidal and post-antibiotic effect, inoculum-independent activity, synergy with beta-lactam and glycopeptide antibiotics, and easy dosing [ 60 ]. With respect to collagen-based dressings with antibiotics, gentamicin is the most frequently investigated antibiotic and is clinically approved worldwide [ 61 ].…”

“…With respect to collagen-based dressings with antibiotics, gentamicin is the most frequently investigated antibiotic and is clinically approved worldwide [ 61 ]. Gentamicin-containing collagen sponges have been previously shown to be effective at preventing infections in clinical cases [ 60 , 62 ]. The common biomechanism of the collagen sponge’s application is to be gradually degraded by native collagenase and absorbed systemically.…”

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

“…[1] Despite all of these advancements, the frequency of sternal wound infections (SWIs) has not decreased [1][2][3][4] with overall incidence rates ranging from 0. [3][4][5][6][7][8].2% after open heart surgery. [5] However, depending on the patient's risk factors, the rates can be as high as 12-20%.…”

“…[5] However, depending on the patient's risk factors, the rates can be as high as 12-20%. [6] In addition, SWIs significantly influence both early and late mortality rates.…”