2543
Views & Citations1543
Likes & Shares
INTRODUCTION
Staphylococcus aureus is the most common cause of surgical wound infection. Staph infection after cardiac surgery results in significant morbidity and mortality. However, the morbidity and mortality rates are notably highest in cases of DSWI caused by methicillin resistant Staphylococcus aureus. Predicting their occurrence is essential for (MRSA) future prevention [3]. A well-known fact is that pre-operative prophylaxis measures significantly designed to prevent S. aureus infections should target the entire patient population not only to patients at elevated risk for these infections to efficiently decrease the risk of infection.
Proven and well accepted strategies to prevent DSWI include maintaining serum glucose <180 mg/dl with continuous insulin infusions in patients with or without diabetes mellitus in ICU [4], clinical process improvements, weight loss, smoking cessation efforts, and interventions targeting Staphylococcus aureus (nasal decolonization and vaccine) [3]. The current recommendations and interventions targeting Staphylococcus aureus are designed to reduce the duration of perioperative intravenous antibiotics for 24-48 h to avoid the emerging antibiotic resistance, another major health care problem and burden [5,6].
Importantly, the benefit of the use of topical vancomycin applied to the sternotomy incision does not result in persistently elevated levels of serum vancomycin following cardiac surgical procedures [7]. Furthermore, topical vancomycin does not potentiate the emergence of drug-resistant infections or contribute to post-operative renal toxicity [7,8]. Whether to add topical vancomycin in the recommendation for preventing post-operative sternal wound infection since Staphylococcus aureus/non-aureus is usually sensitive to vancomycin is still not established.
However, based on available data the efficacy of local antibiotic administration for the prophylaxis of complicated and uncomplicated surgeries, and recommendations supporting this practice for surgical site prophylaxis have not been made yet. Despite that, the use of topical vancomycin should be encouraged or added in the recommendation for prevention of sternal wound infection, as it is easy to prepare and handle and is relatively in expensive. It provides effective hemostasis for bleeding from the sternum because it readily adheres to cut bone surfaces or open bone fractures. Additionally, it also provides bacteriostatic and bactericidal protection against gram-positive organisms that normally cause infections such as Staphylococcus and Streptococcus [5].
1. Alasmari FA, Tleyjeh IM, Riaz M, Greason KL, Berbari EF, et al. (2010) Temporal trends in the incidence of surgical site infections in patients undergoing coronary artery bypass graft surgery: A population-based cohort study, 1993 to 2008. Mayo Clinic Proc 87: 1054-1061
2. Sjogren J, Malmsjo M, Gustafsson R, Ingemansson R (2006) Poststernotomy mediastinitis: A review of conventional surgical treatments. Vacuum-assisted closure therapy and presentation of Lund University Hospital mediastinitis algorithm. Eur J Cardiothorac Surg 30: 898-905.
3. Fowler VG Jr, O’Brien SM, Muhlbaier LH, Corey GR, Ferguson TB, et al. (2005) Clinical predictors of major infections after cardiac surgery. Circulation 112: 1358-1365.
4. Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, et al. (2009) The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. Ann Thorac Surg 87: 663-669.
5. Lazar HL, Ketchedjian A, Haime M, Karlson K, Cabral H (2014) Topical vancomycin in combination with perioperative antibiotics and tight glycemic control helps to eliminate sternal wound infections. J Thorac Cardiovasc Surg 148: 1035-1040.
6. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, et al. (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 70: 195-283.
7. Lazar HL, Barlam T, Cabral H (2011).The effect of topical vancomycin applied to sternotomy incisions on post-operative serum vancomycin levels. J Cardiac Surg 26: 461-465.
8. Huiras P, Logan JK, Papadopoulos S, Whitney D (2012) Local antimicrobial administration for prophylaxis of surgical site infections. Pharmacotherapy 32: 1006-1019.
9. Bonaros N, Schachner T, Lehr E, Kofler M, Wiedemann D, et al. (2013) Five hundred cases of robotic totally endoscopic coronary artery bypass grafting: Predictors of success and safety. Ann Thorac Surg 95: 803-812.
10. Cheng DC, Martin J, Lal A, Diegeler A, Folliguet TA, et al. (2011) Minimally invasive versus conventional open mitral valve surgery: A meta-analysis and systemic review. Innovations (Phila) 6: 84-103.
11. McClure RS, Athanasopoulos LV, McGurk S, Davidson MJ, Couper GS, et al. (2013) One thousand minimally invasive mitral valve operations: Early outcomes, late outcomes and echocardiographic follow-up. J Thorac Cardiovasc Surg 145: 1199-1206.
QUICK LINKS
- SUBMIT MANUSCRIPT
- RECOMMEND THE JOURNAL
-
SUBSCRIBE FOR ALERTS
RELATED JOURNALS
- Journal of Alcoholism Clinical Research
- International Journal of Clinical Case Studies and Reports (ISSN:2641-5771)
- Journal of Spine Diseases
- Journal of Cardiology and Diagnostics Research (ISSN:2639-4634)
- Ophthalmology Clinics and Research (ISSN:2638-115X)
- International Journal of Anaesthesia and Research (ISSN:2641-399X)
- Stem Cell Research and Therapeutics (ISSN:2474-4646)