Vander Salm T J, Okike O N, Pasque M K, Pezzella A T, Lew R, Traina V, Mathieu R
University of Massachusetts Medical Center, Worcester 01655.
J Thorac Cardiovasc Surg. 1989 Oct;98(4):618-22.
Sternal or mediastinal infection after heart operations occurs infrequently but carries a high cost in money, morbidity, and mortality. At our hospital, Staphylococcus nonaureus causes most of these infections and is uniformly sensitive to vancomycin. In a prospective study of 416 patients having cardiac operations, randomized by hospital record number, topical vancomycin was applied to the cut sternal edges in 223 patients (group V) and was omitted in the control group (C) of 193 patients. The vancomycin was applied in a hemostatic paste of topical thrombin and powdered absorbable gelatin; in the control group only the hemostatic paste was applied. All patients received prophylactic systemic antibiotics for 2 days. Sternal infection occurred in one patient in group V (0.45%) and in seven patients in group C (3.6%) (p = 0.02). Infection also correlated with longer operative times (p = 0.027). By multivariate testing, vancomycin (p = 0.013) and shorter operative times (p = 0.014) independently predicted reduced infection rates. In the one patient with an infection in group V, Staphylococcus aureus was cultured; this organism was also cultured in two patients in group C, with Staphylococcus nonaureus being the culprit in the other five patients with sternal infections in group C. Topical vancomycin applied to the cut sternal edges reduces the risk of postoperative sternal infection.
心脏手术后胸骨或纵隔感染虽不常见，但在金钱、发病率和死亡率方面代价高昂。在我们医院，非金黄色葡萄球菌是这些感染的主要致病菌，且对万古霉素均敏感。在一项对416例接受心脏手术患者的前瞻性研究中，根据医院记录编号进行随机分组，223例患者（V组）的胸骨切口边缘应用局部万古霉素，193例患者的对照组（C组）未应用。万古霉素应用于含局部凝血酶和可吸收明胶粉的止血糊剂中；对照组仅应用止血糊剂。所有患者均接受2天的预防性全身抗生素治疗。V组1例患者发生胸骨感染（0.45%），C组7例患者发生胸骨感染（3.6%）（p = 0.02）。感染也与手术时间较长相关（p = 0.027）。通过多变量检测，万古霉素（p = 0.013）和较短的手术时间（p = 0.014）独立预测感染率降低。V组发生感染的1例患者培养出金黄色葡萄球菌；C组也有2例患者培养出该菌，C组另外5例胸骨感染患者的致病菌为非金黄色葡萄球菌。胸骨切口边缘应用局部万古霉素可降低术后胸骨感染的风险。
