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In the case of emergency re-sternotomy - additional antibiotics yes, but an iodine washout?

Leiden University Medical Center, Department of Cardio-thoracic Surgery, Albinusdreef 2, 2333 AC Leiden, NL

Should additional antibiotics or an iodine washout be given to all patients who suffer an emergency re-sternotomy on the cardiothoracic intensive care unit?

In our experience of patients who require an emergency re-sternotomy on the intensive care unit, the incidence of a mediastinal infection is not elevated compared with the normal cardiac surgery population. In our institution we use one additional shot of antibiotics in such circumstances, but have never performed an iodine washout as suggested by the authors [1]. Of course it is possible that our patients have just been very lucky over the last twenty years. A full aseptic technique is something to recommend and to aim for, however, it can be very difficult to put into practice when a patient needs external cardiac massage.

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1. Yap EYL, Levine A, Strang T, Dunning J. Should additional antibiotics or an iodine washout be given to all patients who suffer an emergency re-sternotomy on the cardiothoracic intensive care unit? Interact CardioVasc Thorac Surg 2008;7:464–469.[Abstract/Free Full Text]

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