De Santo Luca Salvatore, Rubino Antonino Salvatore, Torella Michele, De Feo Marisa, Galgano Viviana, Guarente Nicola, Mango Emilio, Savarese Leonardo, Iorio Francesco, Zebele Carlo
University of Campania Luigi Vanvitelli, Department of Translational Medical Sciences, V Monaldi Hospital, Cardiac Surgery Unit, Naples, Italy.
Casa di Cura Montevergine, Intensive Care Unit, Mercogliano, Avellino, Italy.
Sci Rep. 2020 May 4;10(1):7400. doi: 10.1038/s41598-020-64310-y.
Deep sternal wound infections (DSWI), although an infrequent complication, significantly impair postoperative outcomes after coronary artery bypass grafting (CABG) surgery. Among several preventive strategies, topical antibiotic therapy immediately before sternal closure has been strongly advocated. In this retrospective analysis, the incidence of DSWI in 517 patients undergoing isolated CABG and receiving rifampicin irrigation of mediastinum, sternum and suprasternal tissues was compared to an historical consecutive cohort of 448 patients. To account for the inherent selection bias, a 1:1 propensity matched analysis was performed. Patients receiving topical rifampicin experienced significantly less occurrence of postoperative DSWI (0.2% vs 2.5%, p = 0.0016 in the unmatched analysis; 0.3% vs 2.1%, p = 0.0391 in the matched analysis). Intensive care unit stay, hospital stay, and operative mortality were similar between groups. This study shows that topical rifampicin in combination with commonly prescribed preventative strategies significantly reduces the incidence of DSWI to less than 0.3% in unselected patients undergoing a full median sternotomy for CABG. Further studies, including a larger number of patients and with a randomization design, would establish the potential preventative role of topical rifampicin in reducing the occurrence of DSWI.
深部胸骨伤口感染（DSWI）虽是一种罕见的并发症，但会显著影响冠状动脉搭桥术（CABG）后的术后结果。在多种预防策略中，强烈主张在胸骨闭合前立即进行局部抗生素治疗。在这项回顾性分析中，将517例行单纯CABG并接受纵隔、胸骨和胸骨上组织利福平冲洗的患者的DSWI发生率与448例历史连续队列患者进行了比较。为了考虑内在的选择偏倚，进行了1:1倾向匹配分析。接受局部利福平治疗的患者术后DSWI的发生率显著更低（未匹配分析中为0.2%对2.5%，p = 0.0016；匹配分析中为0.3%对2.1%，p = 0.0391）。两组之间的重症监护病房住院时间、住院时间和手术死亡率相似。本研究表明，在接受全胸骨正中切开术进行CABG的未选择患者中，局部利福平联合常用的预防策略可将DSWI的发生率显著降低至低于0.3%。包括更多患者且采用随机设计的进一步研究，将确定局部利福平在降低DSWI发生率方面的潜在预防作用。
