Abdul Bari Khan, Farha Idris, Mudassir I Dar, Sadqa Aftab.
Incedence of sternal wound infection with topical use of vancomycin / gentacin and without topical medication under same intravenous antibiotic coverage.
J Pak Orthop Assoc Jan ;20(1):1-10.

Objectives: To assess and compare the effects of topical antibiotic Vancomycin-Fentacin versus no topical antibiotic in the preventing postoperative sternal wound infection after open-heart surgery. Study Design: Prospective, interventional comparative randomized control trial. Place and Duration of study: Department of Cardiac Surgery, Dow University of Health Sciences, Civil Hospital Karachi, from January 2007 to February 2008. Patient and Methods: Cardiac patient (n=60) operated mainly for Coronary Artery Bypass Grafting (94.25%), Valvular disease (5.72%) were randomly included in our study. Patients were prospectively randomized into three groups with all receiving preoperative intravenous antibiotic: Group A (n=20) received topic vancomycin (1gm) application over the sternotomy wound at primary closure. Group B received topical gentacin (80mg) over the sternotomy wound and Group C (n=20) were the control group. Preoperative and intraoperative variables were equal in all three groups. Endpoint was any sternal wound infection within 6 months postoperatively. Evaluations were double blind and were made on an intention-to-treat basis. Results: Evaluation was possible in 60 patients compared to 66 which were included in the study. The incidence of sternal wound infection was 5% in the treatment group and 20% in the control group. Only one in the control group required removal of sternal wire. Early re-operation for bleeding was more common in the treatment group (12.5% Vs. 10%). No difference in postoperative renal function was noted. Conclusion: Prophylactic topical antibiotic Vancomycin/Gentacin reduced the risk of postoperative sternal wound infection. Further studies are warranted to confirm these results as the study group is small, particularly regard to deep infections.

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