Vogt PR1*, Darrall A2, Berdat PA1, Santoro G3, Schmidlin D4, Khubulava GG5, Marchenko S5, Andreas M6, Laufer G6, Tabori E7 and Schulz-Stübner S7
1Department of Cardiovascular Surgery, Cardiovascular Centre Zurich, Switzerland
2Statworx Science Data, Germany
3Deparment of Hygiene and Infection Prevention, Klinik Im Park, Switzerland
4Department of Anaesthesia and Reanimation, Klinik Im Park, Switzerland
5Departement of Cardiovascular Surgery, Military Medical Academy, Russia
6Department of Surgery, Medical University of Vienna, Austria
7BZH GmbH Deutsches Beratungszentrum für Hygiene, Germany
Background: Sternal wound infections continue to be a major source of morbidity and mortality after cardiac surgery. We undertook a multinational study to determine whether a detailed infection prevention protocol using a specific pre-, intra- and postoperative strategy including topical application of antibiotics would reduce the incidence of sternal infections.
Design: Quasi-Experimental Observation. Setting: Four heart centres in three different countries. Patients: 8,168 consecutive patients undergoing cardiac surgery from February 2006 to June 2015.
Method: In both groups, a second-generation cephalosporin was given prior to surgery and repeated if surgery exceeded six hours. Group A, but not Group B patients, received additional three doses of antibiotics after surgery while group B received intraoperative topical antibiotics and a special sternal closure protocol. Welch’s t-tests and χ2 analyses were used to test statistical significance. Additionally, logistic regression analyses were applied separated into Group A and B in order to examine the potential impact of established risk factors for sternal wound infections.
Results: There was a significant difference of major outcome parameters in favour of Group B vs. Group A: incidence of superficial wound infection: 0.4% vs. 2.9% (p<0.001); deep sternal wound infection: 0.6% vs. 2.2% (p<0.001); number of infection related reoperations: 81 vs. 241 (p<0.001) and number of muscle flap reconstruction in patients with sternal destruction: 0.2% vs. 1.1% (p<0.001).
Conclusion: The presented infection prevention protocol reduces postoperative sternal wound infections and limits the use of systemic postoperative antibiotics.
Vogt PR, Darrall A, Berdat PA, Santoro G, Schmidlin D, Khubulava GG, et al. Reduction of Sternal Wound Infections with a Refined Surgical Technique and Single Shot Systemic and Sternal Spongiosa Topical Antibiotic Prophylaxis Compared to 24 Hours Systemic Antibiotics. Am J Clin Microbiol Antimicrob. 2019; 2(2): 1036.