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- Title
Vancomycin Local application, role in Deep Sternal Wound Infection in our experience.
- Authors
Jadhao, Manish; Shah, Vaibhav; Raut, Chaitanya; Mishra, Prashant; Khandekar, Jayant; Surana, Kuntal
- Abstract
Introduction: Deep sternal wound infection (DSWI) is one of the most complex and potentially devastating complications following median sternotomy in cardiac surgery. Despite many advances in prevention, it still remains significant and ranges between 0.5% and 6.8%. We aim to study the role of vancomycin paste applied locally over sternal edges in reducing DSWI. Materials and Methods: We retrospectively collected data of patients who underwent open heart surgery from June 2017 to May 2019 in our institution. The rate of DSWI was compared in patients in whom vancomycin paste was applied and not applied. Vancomycin paste was prepared using 3 g of vancomycin with 4ml 0.9% normal saline and stirred until a ‘paste’ was formed. This vancomycin paste was applied just after sternotomy and at the time of sternal closure. The rate of DSWI was compared also compared in the following high risk sub groups: female patients, diabetes mellitus (DM), morbidly obese (Body Mass Index i.e. BMI>30) and chronic obstructive lung diseases (COPD). Results: A total of 862 patients underwent open heart surgery during the specified period. Overall incidence of DSWI in our study was 3.48 %. DSWI was found to be significantly lower in vancomycin group (adjusted Odds ratio 2.116 and p=<0.0001) than in the non vancomycin group, vancomycin independently lowered DSWI in all the groups on logistic regression analysis. Diabetes and obesity were statistically significant risk factors for DSWI. Gender, COPD and type of surgery did not affect the incidence of DSWI significantly. No death was recorded due to primary cause as DSWI in patients in our study. Conclusion: Vancomycin paste application over sternal edges is an effective method to prevent DSWI. The use of local vancomycin paste application is recommended especially in patients with co morbidities like diabetes mellitus and morbidly obese (BMI>30) patients. These results need to be substantiated in randomized controlled trials and multiple centers.
- Subjects
STERNUM surgery; WOUND infections; VANCOMYCIN; OBSTRUCTIVE lung diseases; LOGISTIC regression analysis; BODY mass index
- Publication
Journal of Cardio-Thoracic Medicine, 2020, Vol 8, Issue 1, p571
- ISSN
2345-2447
- Publication type
Article