EComment. Gentamicin-impregnated collagen sponge for high-risk cardiac surgery patients

Abstract

I read with great interest the paper by Birgand et al. regarding the use of gentamicin-collagen sponges in closure of sternal wounds in high- risk cardiac surgery patients to reduce the incidence of deep sternal wound infections [1]. They conducted a single-centre prospective cohort study enrolling 552 high-risk patients for sternal wound infection. The primary end-point, which is reoperation for deep sternal wound infection, occurred in 40/298 (13.8%) in the group without the antibiotic implants and in 22/175 (12.6%) in the treated group with the gentamicin-collagen sponges. The authors concluded that gentamicin-collagen sponges are not effective in preventing deep sternal wound infections in high-risk patients undergoing cardiac surgery. Gentamicin-collagen sponges were introduced in 1985 for the prevention of surgical site infection and they are mainly used after laparotomy [2]. However, there is no consensus about their use in patients undergoing cardiac surgery [3]. A recently-published review of the literature and a meta-analysis showed conflicting results. A best evidence topic in cardiac surgery concerning the use of gentamicin-collagen sponges to reduce wound infections was recently published in this journal [4]. The authors of this paper concluded that the use of this implant did not reduce the incidence of sternal wound infection in high-risk patients after cardiac surgery. Recently, a meta-analysis of randomized controlled trials was performed by Mavros et al [5]. Four randomized controlled trials were included in this meta-analysis. All 4 trials were considered of high quality (score of 3 or more according to the modified Jadad criteria). By pooling data provided by 4 published trials (4672 patients), gentamicin-collagen sponge use demonstrated a significant reduction in the rate of deep sternal wound infection (RR, 0.62; 95% CI, 0.39-0.97; P =0.04). Regarding the incidence of superficial sternal wound infection, gentamicin-collagen sponges use seemed to add no benefit (RR, 0.65; 95% CI, 0.34- 1.25; P =0.20). Therefore, in view of the clinical implications of their findings from this meta-analysis, the authors suggest that routine prophylactic retrosternal placement of gentamicin-impregnated sponges reduces the incidence of deep sternal wound infection. The implementation of this simple measure could bring particular benefits in high-risk patients. With the purpose of elaborating consensus guidelines for the best management of these high-risk patients, and to draw definitive conclusions, future studies with larger numbers of patients are required. Conflict of interest: none declared