Chan Joshua L, Diaconescu Andrada C, Horvath Keith A
Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Ann Thorac Surg. 2017 Nov;104(5):1496-1500. doi: 10.1016/j.athoracsur.2017.04.017. Epub 2017 Jul 12.
The development of sternal wound infections remains a serious complication after cardiac surgery. A number of studies have assessed the use of topical antibiotics placed on the sternal edges. We evaluated the routine use of bacitracin ointment applied over the sternotomy skin incision as a prophylactic measure against sternal wound infections.
A retrospective review of all coronary artery bypass graft and valve surgery cases performed at a single institution between 2006 and 2015 was performed (n = 1,495). Appropriate preoperative intravenous antibiotics were administered for all patients. Bacitracin topical antibiotic ointment was routinely applied to the sternal surgical incision after skin closure for all patients during this period. The incidence of sternal wound infection was assessed.
During this 9-year experience, no episodes of deep sternal wound infections were observed, compared with a predicted rate of 0.29% (interquartile range: 0.19% to 0.46%) based on The Society of Thoracic Surgeons National Database risk calculator. Four episodes of superficial sternal wound infections were noted; gram-positive organisms were cultured in the majority of these cases. Bacitracin ointment was well tolerated by patients, with no serious adverse effects reported.
This study suggests that the routine application of topical bacitracin over the surgical skin incision is safe after cardiac surgery. Deep sternal wound infections were notably absent during this period. As a readily available and inexpensive therapy, this simple intervention may be a useful adjunct strategy in preventing sternal wound infections.
心脏手术后胸骨伤口感染的发生仍然是一种严重的并发症。许多研究评估了在胸骨边缘使用局部抗生素的情况。我们评估了在胸骨切开皮肤切口上常规使用杆菌肽软膏作为预防胸骨伤口感染的措施。
对2006年至2015年在单一机构进行的所有冠状动脉旁路移植术和瓣膜手术病例进行回顾性研究（n = 1495）。所有患者术前均给予适当的静脉抗生素治疗。在此期间，所有患者在皮肤缝合后常规将杆菌肽局部抗生素软膏应用于胸骨手术切口。评估胸骨伤口感染的发生率。
在这9年的经验中，未观察到深部胸骨伤口感染病例，而根据胸外科医师协会国家数据库风险计算器预测的发生率为0.29%（四分位间距：0.19%至0.46%）。记录到4例表浅胸骨伤口感染；这些病例中的大多数培养出革兰氏阳性菌。患者对杆菌肽软膏耐受性良好，未报告严重不良反应。
本研究表明，心脏手术后在手术皮肤切口上常规应用局部杆菌肽是安全的。在此期间明显没有深部胸骨伤口感染。作为一种容易获得且廉价的治疗方法，这种简单的干预措施可能是预防胸骨伤口感染的一种有用的辅助策略。
