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Collagen-gentamicin implant for prevention of sternal wound infection; long-term follow-up of effectiveness

^a Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, SE 70185 Örebro, Sweden
^b Department of Cardiothoracic Surgery, Linköping University Hospital, Linköping, Sweden
^c Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden
^d Division of Clinical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
^e Department of Clinical Microbiology, Örebro University Hospital, Örebro, Sweden

*Corresponding author. Tel.: +46 19 6025202; fax: +46 19 6113943.

E-mail address: orjan.friberg{at}orebroll.se (Ö. Friberg).

In a previous randomized controlled trial (LOGIP trial) the addition of local collagen-gentamicin reduced the incidence of postoperative sternal wound infections (SWI) compared with intravenous prophylaxis only. Consequently, the technique with local gentamicin was introduced in clinical routine at the two participating centers. The aim of the present study was to re-evaluate the technique regarding the prophylactic effect against SWI and to detect potential shifts in causative microbiological agents over time. All patients in this prospective two-center study received prophylaxis with application of two collagen-gentamicin sponges between the sternal halves in addition to routine intravenous antibiotics. All patients were followed for 60 days postoperatively. From January 2007 to May 2008, 1359 patients were included. The 60-day incidences of any SWI was 3.7% and of deep SWI 1.5% (1.0% mediastinitis). Both superficial and deep SWI were significantly reduced compared with the previous control group (OR=0.34 for deep SWI, P<0.001). There was no increase in the absolute incidence of aminoglycoside resistant agents. The majority of SWI were caused by coagulase-negative staphylococci (CoNS). The incidence of deep SWI caused by Staphylococcus aureus was 0.07%. The results indicate a maintained effect of the prophylaxis over time without absolute increase in aminoglycoside resistance. (ClinicalTrials.gov NCT00484055 [ClinicalTrials.gov] )

Key Words: Wound infection; Antibiotics; Mediastinitis; Statistics; Regression analysis; Risk factors; Cardiac surgery; Complications