Abstract
Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration. There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be effective against bacteria that are considered resistant to gentamycin and other antibiotics.However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of antimicrobial resistance.We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness. They should be used in dry condition and should not be soaked in saline even for a short period prior to use. However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be sufficiently powered to address this issue, multicenter studies might be the way forward.Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection.
Highlights
Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery
After positive experience in other specialties with topical antibiotic preparations, resorbable gentamicin-containing collagen implant (GCCI) has been introduced in cardiac surgery in an effort to reduce the incidence of sternal wound complications [7,8,9]
This study provides clinching evidence that even a short period of dipping of Collatamp implants, before insertion into the patient results in a significant loss of gentamicin which may be of clinical significance [72]
Summary
The patients in the GCCI group had a lower rate of deep wound infection compared to the control group, this difference did not reach statistical significance [50]. Most of these studies compared GCCI versus routine antibiotic prophylaxis and suffered from a limitation as there were no control arms for Collagen sponge without Gentamycin. Pooled data from 2 randomized controlled trials (3410 patients), showed that use of GCCI reduced the need for surgical revision of sternal wounds (risk ratio, 0.59; 95% confidence interval, 0.41-0.86). As a result several studies are small, inadequately powered and it’s difficult to draw firm conclusions from such studies
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