Empleo de vancomicina tópica en la profilaxis de infección de herida de esternotomía: experiencia inicial

Abstract

IntroductionTopical vancomycin has demonstrated effectiveness in decreasing the incidence of surgical wound infection; however, its usefulness in cardiac surgery remains in doubt. ObjectivesTo analyse the effectiveness of topical vancomycin in the reduction of sternal wound infection in cardiac surgery. Material and methodA retrospective observational study was conducted to compare the incidence of sternotomy infection in a cohort in which the usual antibiotic prophylaxis was used, with another cohort in which topical vancomycin was also used. ResultsA total of 525 patients were included in the study, with 47.43% in the group treated with vancomycin. The incidence of infection was significantly higher in the group without vancomycin (3.6% versus 10.1%), implying a relative risk of infection of 2.8 (95% CI; 1.35-5.83, p=.0035). The differences were statistically significant as regards the incidence of superficial and deep infections (p=.05), but did not reach statistical significance in organ-space infection (p=.22). The beneficial effect of vancomycin was maintained in a logistic regression model adjusted for possible confounding factors (smoking, re-operation, nephropathy, and NYHA functional grade class): odss ratio 3.48 (95% CI; 1.44-8.41, p=.006). Gramnegative microorganisms were the main causative agent in the vancomycin group (57.1%), whereas it was grampositive in the group without vancomycin (66.70%), although these differences did not reach statistical significance. ConclusionThe use of topical vancomycin decreases the incidence of superficial and deep sternotomy wound infections. Its use could lead to a change in the aetiological spectrum of sternal wound infection.