Mishra Pankaj Kumar, Ashoub Ahmed, Salhiyyah Kareem, Aktuerk Dincer, Ohri Sunil, Raja Shahzad G, Luckraz Heyman
Cardiothoracic Unit, Heart and Lung Centre, Wednesfield Road, Wolverhampton WV10 0QP, UK.
J Cardiothorac Surg. 2014 Jul 8;9:122. doi: 10.1186/1749-8090-9-122.
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.
胸骨伤口感染（SWI）仍是心脏手术后令人担忧的主要原因。它会导致住院时间延长、发病率和死亡率增加以及医院成本上升。预防性全身使用抗生素已被用于预防手术部位感染（SSI）。然而，术后长期使用全身抗生素会导致耐药菌的出现。含庆大霉素的胶原蛋白植入物（GCCI）在胸骨切开术闭合期间使用时，伤口局部抗生素浓度高而血清浓度低。有证据表明，纵隔液中庆大霉素的浓度达到足够高的水平，足以有效对抗被认为对庆大霉素和其他抗生素耐药的细菌。然而，人们对GCCI的安全性和有效性提出了质疑。有人担心GCCI是否会导致肾功能损害时的全身吸收，以及局部使用抗生素是否会导致抗菌药物耐药性的出现。在此，我们回顾了关于GCCI（Collatamp）的文献，并借此机会向科学界评估它们在心脏手术中的作用。最近的几项研究支持了它们的临床有效性。它们应在干燥状态下使用，甚至在使用前短时间内也不应浸泡在盐水中。然而，要使GCCI成为心脏手术常规操作的一部分，还需要进一步的大型随机研究。由于心脏外科专业中胸骨伤口感染的发生率较低，对于任何有足够能力解决这一问题的研究来说，多中心研究可能是前进的方向。基于本手稿中提供的证据，建议GCCI（Collatamp）可以作为预防胸骨伤口感染的一种具有成本效益的辅助手段。它们也可用于治疗深部胸骨伤口感染。
